Utility of Steroid Nasal Irrigation after Surgical Resection for Inverted Papilloma

Introduction: Use of steroid irrigation in management of chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS) suggests improved outcomes.[1] However, literature regarding postoperative management after ESS for inverted papilloma (IP), is less clear.[2] Currently, there is discrepancy on the usage of nasal saline rinses versus steroid rinses in optimizing long-term patient quality of life (QoL) after endoscopic IP resection. This study analyzed post-operative outcomes to determine optimal management with regard to irrigation type in patients after ESS for IP.

Methods: A retrospective cohort study was performed of patients undergoing ESS for IP at a tertiary care center between 2012 and 2019. Patients were divided into 2 cohorts: post-operative saline rinses (control) versus postoperative steroid rinses (treatment). Surgical approach, recurrence, post-operative nasal rinse type, and baseline demographic data were recorded. Subjective QoL scores were analyzed using an established metric, the Sino-nasal Outcome Test (SNOT-22), collected pre-operatively and post-operatively at 1-, 3-, 6-, 12-, 18-, and 24-month intervals. Higher SNOT-22 scores indicated increased symptom burden on QoL. Student's t-tests were used to compare SNOT-22 scores in each cohort at the various time points. A p-value < 0.05 was considered statistically significant.

Results: A total of 126 patients with IP were analyzed, with 41 patients in the control group (post-operative saline rinses) and 85 patients in the treatment group (post-operative steroid rinses). 15 patients in the control group and 23 patients in the treatment group required revision surgery. There was no statistically significant difference in SNOT-22 scores pre-operatively (p = 0.20) or at one month post-operatively (p = 0.84), however baseline SNOT-22 was lower in the group treated with post-operative saline rinses. At 3, 6, 12, and 18 months post-operatively, SNOT-22 scores were significantly different between the 2 groups (p = 0.0068, p = 0.016, p = 0.001, p = 0.025, respectively) with lower scores in the control group ([Fig. 1]). At 24 months postoperatively, the difference between the two cohorts was not statistically significant (p = 0.13); however, the mean SNOT-22 scores of the saline group remained lower than those of the steroid group (9.91 vs. 18.24).

Conclusion: Compared with steroid irrigation, the saline irrigation group had a statistically significant decrease in SNOT-22 QoL scores up to 2 years postoperatively. These outcomes suggest that preoperative degree of sinonasal inflammation secondary to IP is more clinically meaningful than postoperative medical treatment of inflammation with steroids in terms of QoL outcomes. Alternatively, these results may suggest that the disease process of IP is fundamentally different to that of CRS, which has been proven to have improved outcomes following steroid irrigation. Randomized trials involving allocation to saline versus steroid postoperative management are necessary to further clarify this relationship.

Fig. 1 Pre-operative and post-operative SNOT-22 scores for patients undergoing ESS of IP, with error bars indicating standard error (*p<0.05).

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022

• References

• Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol 2018; 8 (04) 461-470
• Jo HW, Dalgorf DM, Snidvongs K, Sacks R, Harvey RJ. Postoperative irrigation therapy after sinonasal tumor surgery. Am J Rhinol Allergy 2014; 28 (02) 169-171