This meta-analysis and systematic review from the Netherlands and the UK aims to answer the question of whether corticosteroids inhaled and / or taken orally are beneficial to patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery. Refreshingly 18 RCTs made it through the selection process with a total of 1309 patients studied. Outcomes were broadly assessed in four categories, operative outcomes, e.g. estimated blood loss, surgical field quality and operative time; anaesthetic related outcomes, postoperative outcomes, e.g. symptom score, endoscopic score, risk of sinusitis and also risk of recurrence. Patients who had taken inhaled or oral corticosteroids were grouped together and compared to patients who had either taken a placebo or no corticosteroids. There are good representations of the statistics in the form of Forrest plots and these very nicely show a significant reduction in operating time, blood loss and an improvement in surgical field quality, although the number of studies that make it through to some of the points diminishes.
Risk of polyp recurrence is lower in the postoperative corticosteroid group, which is to be expected. Overall it would seem that there is good evidence to support the use of corticosteroids prior to sinus surgery. No mention of any side effects or complications of the steroids is given however.
