Efficacy of Topical Corticosteroid Therapy in Chronic Rhinosinusitis Post-endoscopic Sinus Surgery: A Narrative Synthesis of Randomized Controlled Trials

Chronic rhinosinusitis (CRS) is a frequent inflammatory disorder that can markedly impair patients' quality of life. Endoscopic sinus surgery (ESS) remains the treatment of choice for refractory cases, but postoperative inflammation and adhesion formation are still major concerns. Corticosteroids are often prescribed to address these complications, although systemic administration carries the risk of adverse effects. This has led to growing interest in localized, topical corticosteroid therapies. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Eligible studies included randomized controlled trials (RCTs) comparing topical corticosteroid interventions with standard postoperative care or placebo in CRS patients undergoing ESS. Searches were conducted in PubMed and Google Scholar up to July 2024. Data extraction and quality appraisal were independently performed by two reviewers, with disagreements resolved by a third reviewer. Of the 141 screened records, six RCTs comprising 530 participants met the inclusion criteria. Pooled analysis indicated that topical corticosteroids enhanced mucosal recovery, decreased adhesion (synechiae) rates, and reduced polyp recurrence. Drug-eluting stents and budesonide irrigation demonstrated the most notable benefits without significant systemic complications. Patient-reported improvements were consistently documented using the Sino-Nasal Outcome Test-22 (SNOT-22) and Lund-Kennedy scoring systems. Topical corticosteroid use following ESS offers clear benefits by promoting healing and minimizing complications, with limited systemic risks. Nevertheless, heterogeneity across trials highlights the need for further well-designed studies with standardized methodologies to strengthen the evidence base and guide routine clinical use.