National survey on the use of preoperative systemic steroids in endoscopic sinus surgery.

Background: The use of preoperative systemic steroids (PSS) in endoscopic sinus surgery (ESS) has been a topic of debate among otolaryngologists for many years now. Until recently, most of the evidence to support PSS use in ESS was largely anecdotal and based on expert opinion. Although some recent randomized and blinded trials have been published, opinions among experts in the field are highly variable. The objective of this study is to identify and report the practice patterns of experts in the field regarding the use of PSS.

Methods: A survey instrument was developed using SurveyMonkey® and sent to active members of the American Rhinologic Society (ARS). Responses to questions regarding PSS use, regimen, and benefits were recorded anonymously.

Results: A total of 173 members answered the questionnaire. Although most respondents believe that there is inadequate evidence to support their use, 88.82% of the study population does use PSS in their practice. The most common diagnosis among respondents for using PSS is chronic rhinosinusitis with polyps (CRSwNP), which is consistent with the literature available. We also found statistically significant differences between PSS use in private vs academic practice, showing a trend toward more aggressive management in academic-affiliated physicians.

Conclusion: The current study shows that most of the respondents in our group do in fact see an advantage in the use of PSS before ESS. The data also highlights the opinion of most experts that more research with higher levels of evidence is still lacking.