Management of chronic rhinosinusitis with steroid nasal irrigations: a viable non-surgical alternative in the COVID-19 Era.

BACKGROUND: High-dose, high-volume steroid nasal irrigations (NSI) have been incorporated into the medical management of recalcitrant CRS, primarily following surgical intervention. The objective of this study was to evaluate the role of NSI as a preoperative management and to identify the percentage of patients who ultimately underwent ESS for recalcitrant CRS despite being on NSI. METHODS: Retrospective chart review of patients presenting with CRS who underwent a trial of NSI for at least six weeks. Pre-irrigation and post-irrigation outcomes measured included Lund-Mackay scores (LMS), SNOT-22 scores, and whether or not the patient underwent ESS. RESULTS: Of the 90 patients who underwent NSI, 32 patients underwent ESS, while 58 patients had a significant enough improvement in symptoms to avoid ESS. The likelihood of decision for surgery did not differ between the mometasone and budesonide groups (p=0.3094), comorbid asthma status (p=0.3585), smoking status (p=0.2256), polyp status (p=0.7288), or history of prior ESS (p=0.5803). SNOT scores significantly improvement following NSI in the group of patients that did not go on to ESS (p<0.0001) and in the group that did (p<0.0001). LMS also improved following NSI, but this was only statistically significant in the patients that ultimately went on to ESS (p=0.0102). CONCLUSIONS: After a trial of NSI, 64.4% of patients with CRS no longer met candidacy for ESS and had a significant improvement in SNOT-22 scores. This supports the use of nasal steroid irrigations in the medical management of CRS with and without surgical intervention and with and without nasal polyposis. This article is protected by copyright. All rights reserved.