Efficacy of nasal steroid irrigation in chronic rhinosinusitis after sinus surgery: a meta-analysis study

Abstract

Abstract Objective This study is to evaluate the efficacy of steroid nasal irrigation in chronic rhinosinusitis (CRS) postoperatively and to compare it with saline irrigation alone as regards improvement in SNOT-22 and LKES scores. Data sources A comprehensive electronic search of Medline database, Web of Science, Springer, Cochrane Library, and EMBASE was done in September 2023. The study included relevant published medical articles from 1990 to 2023. Study selection Studies are published in English language, conducted on patients above 18 years old, who underwent endoscopic sinus surgery for CRS and received any kind of steroid irrigation for at least 2 weeks after surgery and who did not receive any postoperative oral steroids or immune modulators. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). Data extraction Sixteen studies were included with 555 patients in single-arm analysis of steroid irrigation group and 816 patients in double-arm analysis. Statistical analysis was done according to SNOT-22 and LKES scores improvement in 2, 6, 12 weeks and 6, 12 months. Results A statistically significant difference was found with steroid nasal irrigation postoperatively in the follow-up period of 2 weeks, 6 weeks, 12 weeks, and 6 months, 12 months in SNOT-22. Also, a statistically significant difference was found with steroid nasal irrigation in comparison to saline irrigation alone postoperatively in the follow-up period of 2 weeks, 6 weeks, and 12 weeks in both SNOT-22 and LKES scores. Conclusion Budesonide nasal irrigation for 6 weeks postoperatively in CRS patients is more effective than saline-alone irrigation and should be introduced into management protocols and guidelines.