Language

English

Publication Date

8-1-2026

Journal

International Forum of Allergy & Rhinology

DOI

10.1002/alr.70211

PMID

42411021

PMCID

PMC13432687

PubMedCentral® Posted Date

7-6-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Chronic rhinosinusitis (CRS) is a prevalent, heterogeneous inflammatory disease associated with significant morbidity. Systemic corticosteroids (SCS) are commonly prescribed for their anti-inflammatory effects, but cumulative exposure carries risks, including metabolic, cardiovascular, and skeletal complications. Despite widespread use, evidence-based guidance on optimal indications, timing, and duration of SCS in CRS remains inconsistent.

Methodology/principal: An evidence-based review was performed using MEDLINE, EMBASE, and Cochrane databases (2013-2023). Studies were screened and categorized into two primary groups: CRS with (CRSwNP) or without (CRSsNP) nasal polyps. Within CRSwNP, evidence was subcategorized by indication, including (1) polyp size reduction, (2) olfactory dysfunction, (3) comorbid disease, and (4) perioperative use, encompassing pre- and postoperative SCS administration. The CRSsNP category included studies evaluating SCS in non-polypoid disease, with or without comorbidities. Recommendations were graded according to evidence quality and the balance of benefit versus harm.

Results: Short courses of SCS provide consistent, short-term improvements in nasal polyp size, nasal congestion, and olfactory function in CRSwNP, but benefits wane within weeks unless followed by intranasal corticosteroids. Preoperative SCS improves intraoperative visualization, though comparable nonsteroidal techniques exist. Routine postoperative SCS are not supported, showing no meaningful advantage over topical therapy. No additional benefit was seen in comorbid subgroups. Evidence in CRSsNP is limited, with possible benefit only in early disease or select medically managed cases. Repeated use contributes to cumulative toxicity.

Conclusions: SCS have a narrow, time-limited role in CRS. Stewardship should emphasize optimized topical therapy, appropriate sinus surgery, and biologics to minimize systemic steroid exposure.

Keywords

Humans, Rhinosinusitis, Adrenal Cortex Hormones, Nasal Polyps, Chronic Disease, Evidence-Based Medicine, Anti-Inflammatory Agents, Sinusitis, Rhinitis, Background: Chronic rhinosinusitis (CRS) is a prevalent, heterogeneous inflammatory disease associated with significant morbidity. Systemic corticosteroids (SCS) are commonly prescribed for their anti-inflammatory effects, but cumulative exposure carries risks, including metabolic, cardiovascular, and skeletal complications. Despite widespread use, evidence-based guidance on optimal indications, timing, and duration of SCS in CRS remains inconsistent. Methodology/principal: An evidence-based review was performed using MEDLINE, EMBASE, and Cochrane databases (2013-2023). Studies were screened and categorized into two primary groups: CRS with (CRSwNP) or without (CRSsNP) nasal polyps. Within CRSwNP, evidence was subcategorized by indication, including (1) polyp size reduction, (2) olfactory dysfunction, (3) comorbid disease, and (4) perioperative use, encompassing pre- and postoperative SCS administration. The CRSsNP category included studies evaluating SCS in non-polypoid disease, with or without comorbidities. Recommendations were graded according to evidence quality and the balance of benefit versus harm. Results: Short courses of SCS provide consistent, short-term improvements in nasal polyp size, nasal congestion, and olfactory function in CRSwNP, but benefits wane within weeks unless followed by intranasal corticosteroids. Preoperative SCS improves intraoperative visualization, though comparable nonsteroidal techniques exist. Routine postoperative SCS are not supported, showing no meaningful advantage over topical therapy. No additional benefit was seen in comorbid subgroups. Evidence in CRSsNP is limited, with possible benefit only in early disease or select medically managed cases. Repeated use contributes to cumulative toxicity. Conclusions: SCS have a narrow, time-limited role in CRS. Stewardship should emphasize optimized topical therapy, appropriate sinus surgery, and biologics to minimize systemic steroid exposure

Published Open-Access

yes

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.