Postoperative Systemic Steroid Use in Rhinosinusitis

General Recommendations for Postoperative Systemic Steroid Use

The EPOS 2020 steering group suggests that 1-2 courses of systemic corticosteroids per year can be a useful addition to nasal corticosteroid treatment in patients with partially or uncontrolled disease 1
Postoperative systemic corticosteroids have not been shown to significantly improve SNOT-22 scores at 1, 3, or 6 months after surgery in general chronic rhinosinusitis with nasal polyps (CRSwNP) patients 2, 3
Short courses of systemic corticosteroids can be associated with adverse effects including insomnia, mood changes, gastrointestinal issues, and rarely more serious complications like avascular necrosis 2

In allergic fungal rhinosinusitis (AFRS) patients, postoperative systemic corticosteroids have shown significant benefits 4, 5
Postoperative systemic corticosteroids improve short-term outcomes in AFRS (Level 1b evidence) 6, 5
Postoperative systemic corticosteroids are likely to reduce long-term recurrence in AFRS (Level 2b evidence) 6, 5
A randomized controlled trial showed that a 6-month postoperative corticosteroid regimen in AFRS patients was associated with less recurrence (10%) compared to a 2-month taper (30%) 4, 5

For general CRSwNP patients, a short course of prednisolone 30-60mg daily for 7-14 days with appropriate tapering is recommended 1, 2
For AFRS patients, longer and more gradual tapering is recommended, such as prednisolone 1mg/kg/day for 1 week preoperatively and 0.5mg/kg/day for 4 weeks postoperatively, then 0.4mg/kg/day for 4 weeks, tapered to 0.2mg/kg/day for 2 months and to 0.1mg/kg/day for the last 2 months 4, 5

Five out of 12 patients in one study developed Cushingoid features and one developed steroid-induced diabetes mellitus after 6 weeks of prednisolone 50mg daily 4
Rare but serious complications can include avascular necrosis 2

Do not rely solely on systemic steroids without appropriate local therapy (intranasal corticosteroids) 1, 6