There is an increasing body of evidence that the role of surgery for chronic rhinosinusitis is to facilitate the delivery of topical medical treatment – most notably, topical corticosteroids. Two recent studies, one using flow dynamics and another one examining the distribution of topical treatment in cadaveric specimens showed that good local delivery of steroid medications is only possible after full ethmoidectomy and wide frontal sinusotomies. However, hard evidence showing the efficacy of delivering topical steroids via nasal douching post FESS was absent – so there was a clear need for a proper, double blinded randomised control trial. This was performed by the Sacks/Harvey group in Australia, by prescribing nasal douching and nasal sprays in both groups, with placebo in the nasal douching in the one group and placebo in the nasal spray in the other.
Although only 44 patients were randomised, the outcomes were both statistically, but also (more importantly) clinically better for the nasal douching group. This group had better results at 12 months post-surgery in VAS for nasal obstruction, nasal endoscopy score and even radiological scoring.
The difference was not significant for SNOT 22, but that may reflect the large improvement (almost 30 points) for both groups. Overall, a well-planned and analysed study that despite the small number of participants, adds to the significant body of evidence that suggests that topical steroids in nasal douching are critical post FESS surgery.
