Endoscopic sinus surgery combined with nasal corticosteroids and surgery alone for chronic rhinosinusitis with nasal polyps: a meta-analysis.

OBJECTIVE

The purpose of this meta-analysis was to assess whether the outcomes of endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps could be improved by adjunctive corticosteroid therapy.

METHODS

This meta-analysis was conducted in accordance with the PRISMA statement. We systematically searched PubMed, Web of Science, and CNKI for clinical studies comparing ESS combined with corticosteroid therapy and ESS alone in patients with CRSwNP.

RESULTS

Eight clinical studies with an aggregate of 776 patients were included. Meta-analysis revealed: (1) A lower rate of polyp recurrence in the ESS plus corticosteroid therapy group (OR = 0.57, 95% CI: 0.33-0.97, P = 0.04); (2) Better sinonasal quality of life (SNOT-22: SMD = - 1.09, 95% CI: - 1.30 to - 0.89, P < 0.00001); (3) Decrease symptom score (VAS: MD = - 3.80, 95% CI: - 4.53 to - 3.07, P < 0.00001); (4) Better endoscopic outcome (Lund-Kennedy: SMD = - 2.05, 95% CI: - 2.27 to - 1.83, P < 0.00001). Heterogeneity was low (I² = 0%-4%), and funnel plots were generated exploratorily because of the limited number of studies.

CONCLUSION

ESS combined with adjunctive corticosteroid therapy was associated with lower recurrence and improved postoperative SNOT-22, VAS, and Lund-Kennedy scores compared with surgery alone in patients with CRSwNP. However, these findings should be interpreted cautiously because endotype-specific effects, corticosteroid delivery methods, surgical extent, and long-term symptomatic recurrence were not consistently reported.