Efficacy of Nasal Steroid Irrigation in Chronic Rhinosinusitis after Sinus Surgery: A Meta-Analysis Study

Abstract

Abstract Background Chronic rhinosinusitis (CRS) is a frequent multifactorial inflammatory disorder that ranges from single sinus disease to extensive sinonasal airway inflammation that reduces the patient's quality of life. The goal of CRS treatment is to decrease infectious exacerbations while controlling inflammation. Methods We conducted a meta-analysis study to assess the efficacy of nasal steroid irrigation in CRS after sinus surgery. This study included published medical articles from 1990 till 2023 concerning the efficacy of nasal steroid irrigation in CRS after sinus surgery through the Medline data base (PubMed), Web of science, Springer, Cochrane library, EMBASE. Results Sixteen studies (n = 678) met the inclusion criteria and were reviewed and analyzed. Nasal steroid irrigation resulted in statistically highly significant improvement (p < 0.01) in both SNOT and LKES at 6 and 12 weeks, and 12 months evaluation after surgery, in SNOT only at 6 months evaluation and in LKES only in 2 weeks evaluation. The improvement in SNOT was statistically significant (p = 0.04) at 2 weeks evaluation, however, there was no statistically significant improvement (p = 0.18) in LKES at 6 months evaluation after surgery. When compared to saline alone irrigation, steroid irrigation resulted in highly statistical improvement in (p < 0.01) in SNOT at 6 weeks and in LKES at 2 weeks and 12 weeks evaluation. It also resulted in statistically significant improvement in SNOT at 2 weeks (p = 0.01) and 12 weeks (p = 0.02) and in LKES at 6 weeks (p = 0.01) and 12 months (p = 0.02), However the improvement wasn’t statistically significant at 6 months (p = 0.35) and at 12 months (p = 0.95) in SNOT and at 6 months (p = 0.10) in LKES. Conclusion The addition of steroid to normal saline for nasal irrigation in CRS patients who underwent functional endoscopic sinus surgery is more effective than saline alone irrigation both subjectively and objectively over short-term follow-up visits.