Differential effects of postoperative oral corticosteroid on eosinophilic vs. non-eosinophilic CRSwNP subtypes.

Abstract

PURPOSE\nThe efficacy of postoperative oral corticosteroids on surgical outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients following endoscopic sinus surgery (ESS) remains controversial. This study evaluated the potential benefits of postoperative oral corticosteroids on surgical outcomes in CRSwNP patients and investigated the differential effects on eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (NECRSwNP).\n\n\nMATERIALS AND METHODS\nPatients with bilateral CRSwNP who underwent ESS were enrolled and randomized to receive either oral prednisolone (30\u202fmg/day) or placebo for 2\u202fweeks after surgery. Visual analog scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22) scores were chosen as the subjective outcomes, evaluated at preoperative baseline and 1, 3, and 6\u202fmonths postoperatively. Lund-Kennedy Endoscopic Scores (LKESs) were used as the objective outcome, evaluated at preoperative baseline and at 2\u202fweeks and 2, 3, and 6\u202fmonths postoperatively.\n\n\nRESULTS\nIn total, 100 patients with bilateral CRSwNP were enrolled, of whom only 82 completed the 6-month follow-up. The subjective outcomes showed no significant difference at each follow-up points. Of the objective outcomes, the corticosteroid group reporting a trend of improvement in LKESs at 6\u202fmonths postoperatively (p\u202f=\u202f0.05). After stratification by tissue eosinophils, only patients with NECRSwNP (<10 eosinophils/HPF) demonstrated a significant improvement in LKESs at 3\u202fmonths postoperatively (p\u202f=\u202f0.03).\n\n\nCONCLUSIONS\nPostoperative oral corticosteroids did not provide additional improvements in VAS and SNOT-22 scores; nevertheless, a trend of LKES improvement was noted at 6\u202fmonths postoperatively. After stratification by tissue eosinophils, this effect was significant only among NECRSwNP patients at 3\u202fmonths follow-up.