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Table 6 Summary of the evidence for ‘efficacy of systemic steroids before endoscopic sinus surgery in CRSwNP’

From: Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Study Year LOE (1a to 5) Study design Study groups Clinical endpoints efficacy Conclusion
Ecevit et al. 2015 1b Prospective double-blind RCT Adults with CRSwNP with surgical indication receiving either oral prednisolone, 60 mg/day for 7 day, then reduced to 10 mg (1 tablet) taken every other day, stopping on d 17 (n = 11) or placebo (n = 10) 1. Perioperative bleeding
2. Visibility of the operative field
3. Operative time
4. Hospital stay
Perioperative bleeding, operative time and hospital stay were significantly reduced in patients who received oral steroids. Visibility of the operative field was significantly better after receiving steroids
Wright et al. 2007 1b Prospective double-blind RCT 26 adult CRSwNP patients with surgical indication receiving either 30 mg of prednisone for 5 days preoperatively or placebo 1. Difficulty of surgery
2. Operative time
3. Peroperative blood loss
Surgeons rated the surgery in the placebo-treated group as more difficult than the steroid-treated group
No differences were noted in operative duration and blood loss
Günel et al. 2015 1b Prospective double-blind RCT 65 adult CRSwNP patients with surgical indication receiving either oral prednisolone (1 mg/kg for 2 days and then tapered down, with treatment completed on the day 10) or placebo 1. Intraoperative blood loss
2. Quality of surgical field
No difference in intraoperative blood loos when patients received oral steroids preoperatively
Non-significant improvement of quality of surgical field after oral steroids
Fraire et al. 2013 3b Prospective non-randomized CT Adult CRS patients with surgical indication (CRSsNP and CSRwNP) receiving either 2×/day 30 mg methylprednisolone on 5 consecutive days prior to surgery (n = 27) vs. no treatment (n = 27) 1. Intraoperative bleeding
2. Surgical time
3. Quality of surgical field
Operative bleeding was significantly reduced in CRSwNP patients who received oral steroids preoperatively. No significance obtained in quality of operating field. No difference in surgical time
Sieskiewicz 2006 1b RCT 36 adult CRSwNP patients with surgical indication receiving either prednisone (30 mg/day for 5 consecutive days directly before the surgery) or no preoperative treatment 1. Intraoperative bleeding
2. Surgical time
3. Quality of surgical field
Quality of the operating field and surgical time were significantly improved in CRSwNP patients who received oral steroids preoperatively. No significance obtained in total blood loss
  1. RCT randomized controlled trial, CRS chronic rhinosinusitis, CRSwNP chronic rhinosinusitis with nasal polyps