Is add-on budesonide-impregnated nasal dressing useful following endoscopic sinus surgery with perioperative oral steroid?

Abstract

Some chronic rhinosinusitis with nasal polyps patients undergoing endoscopic sinus surgery (ESS) have unfavorable results despite proper postoperative treatments including oral and topical steroids. Steroid-impregnated absorbable nasal dressing has been shown to improve outcomes of the surgery. In some clinical practices, budesonide-impregnated nasal dressing is used together with perioperative oral steroid but the additional benefits of it are still unknown. This study aims to determine whether budesonide-impregnated nasal dressing had any benefits following ESS when a short course of oral steroid was given in perioperative period. This is a prospective, double-blinded, within person randomized, placebo-controlled study conducted in tertiary care hospital. Eighteen consecutive patients (36 nostrils) with chronic rhinosinusitis with nasal polyps who underwent bilateral ESS were enrolled. At the end of surgery for each patient, one side of the ethmoid cavity and middle meatus was randomly given polyurethane foam soaked with 2 mL of budesonide inhalation solution (0.5 mg/ 2 mL) (budesonide side), while the contralateral side received 2 mL of normal saline-soaked polyurethane foam (control side). Postoperative care included oral antibiotics, a short course of oral steroid and budesonide nasal irrigations. Single assessor who was blinded to the randomization allocation evaluated mucosal inflammation and wound healing at 2 and 4 weeks after surgery using Perioperative Sinus Endoscopy (POSE) score. Results revealed a total of 36 nostrils were randomized into two groups: 18 to budesonide side and 18 to control side. All of them were analyzed. The preoperative Lund-Mackay computed tomography score did not show a significant difference between groups. There was no significant difference in POSE score between budesonide and control sides at 2 and 4 weeks after surgery. Budesonide-impregnated polyurethane foam did not provide additional benefits on mucosal inflammation and wound healing in the patients who underwent ESS and received a short course of oral steroid perioperatively.