How beneficial is the pre-operative use of steroids in nasal polyposis surgery?
Background: Nasal polyposis is a chronic inflammatory disease of the sinonasal mucosa, causing nasal obstruction, smell and taste disorders, headache, and nasal discharge. Inflammatory cells play a significant role in nasal polyp development.
Surgery is a therapeutic option, but the question of whether or not treatment should begin with corticosteroid therapy prior to surgery is controversial.
Study design: Prospective, double-blind, randomized, placebo-controlled study of 22 patients (10 corticosteroid, 12 control).
Setting: Department of Otorhinolaryngology of Dokuz Eylül University Hospital, Izmir, Turkey.
Synopsis: Either the study drug (10 mg prednisolone/90 mg lactose) or a placebo (100 mg lactose) was given to patients two weeks prior to the scheduled operation. Patients were evaluated for an endoscopic polyp score, computerized tomography opacification score (Lund-Mackay), Connecticut Chemosensory Clinical Research Center (CCCRC) butanol olfactory threshold test, peak nasal inspiratory peak flow (PNIF), and the visual analog scale (VAS). Complication distribution in the corticosteroid group (CG) and placebo group (PG) were two and five, respectively. Complications included one case of orbital fat herniation and one case of anterior nasal packing (CG), and four cases of anterior nasal packing and one case of orbital fat herniation (PG).
Daily use of 60 mg prednisolone for seven days, tapering until day 17, was effective in reducing the symptom scores, PNIF, operation time, and peri-operative blood loss, as well as improving smell thresholds, increasing operative field visibility, and shortening hospital stay time. In CCCRC testing, there was no change in PG but a statistically significant improvement in CG. Limitations included a low sample size and the fact that the academic setting may not reflect daily clinical practice.
Bottom line: Pre-operative administration of systemic corticosteroids shortens the operation time and improves the peri-operative visibility by reducing blood loss.
Citation: Ecevit MC, Erdag TK, Dogan E, Sutay S. Effect of steroids for nasal polyposis surgery: a placebo-controlled, randomized, double-blind study. Laryngoscope. 2015;125: 2041–2045.