Yonsei Med J.  2014 Nov;55(6):1683-1690. 10.3349/ymj.2014.55.6.1683.

Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

• Hong SJ
• Lee JK
• Lee HS
• Lee JY
• Pyo JS
• Lee KC

• KMID: 2070220
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1683

Abstract

PURPOSE
To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome.
MATERIALS AND METHODS
We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade.
RESULTS
There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611).
CONCLUSION
Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

Keyword

Steroid; chronic rhinosinusitis; nasal polyp; endoscopic sinus surgery

MeSH Terms

Adult
Aged
Asthma/complications
Chronic Disease
Endoscopy/*methods
Female
Humans
Inflammation
Male
Middle Aged
Nasal Polyps/complications/diagnosis/*surgery
Odds Ratio
Otorhinolaryngologic Surgical Procedures/*methods
Paranasal Sinuses/pathology
Prednisone/*administration & dosage
Retrospective Studies
Rhinitis/complications/diagnosis/*surgery
Sinusitis/complications/diagnosis/*surgery
Treatment Outcome
Prednisone

Figure

• 

  Fig. 1 Detail of exclusion and classification of study patients. CRS, chronic rhinosinusitis; NP, nasal polyposis; ESS, endoscopic sinus surgery.

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