Is there any point giving postoperative oral steroids after a FESS?
Reviewed by Joanna Stephens

It is well accepted that when medical treatment fails for chronic rhinosinusitis (CRS), endoscopic sinus surgery (ESS) is more effective than continuing with medical therapy alone. A variety of postoperative care options are available, including saline irrigation, in office debridement, antibiotics or steroids; orally or nasally. We know that steroids are effective in reducing postoperative inflammation, however the delivery, amount of steroids and duration varies. This systematic review looks to evaluate the efficacy of oral corticosteroids in patients with CRS following ESS. The authors evaluated 14 randomised control trials (RCTs) with 793 patients in total. Primary outcome measures were SNOT 22 and Lund-Kennedy (LK) endoscopic scores. Interestingly, six of the seven studies showed no change in the recurrence rates between the steroid and non-steroid groups – however, a subgroup analysis of patients with allergic fungal rhinosinusitis showed a significant improvement in outcomes in those treated with oral steroids postop. No difference in outcomes was identified when looking at a tapering regime of steroids vs. no taper, but there were also almost no adverse events associated with the use of steroids postop. In summary, this paper suggests that there is no point in giving oral steroids after ESS unless there is strong evidence of allergic fungal rhinosinusitis, although of course more specific and detailed research would answer this question more clearly.

Postoperative oral corticosteroid use following endoscopic sinus surgery for Chronic Rhinosinusitis: A Systemic review and Meta-analysis.
Shafik J, Sangiuolo K, Sheinin E, et al.
AM J RHINOL ALLERGY
2025;39(4):322–32.