Table 6.

Summary of the evidence for ‘efficacy of systemic steroids before endoscopic sinus surgery in CRSwNP’

Study	Year	LOE (1a to 5)	Study design	Study groups	Clinical endpoints efficacy	Conclusion
Ecevit et al.	2015	1b	Prospective double-blind RCT	Adults with CRSwNP with surgical indication receiving either oral prednisolone, 60 mg/day for 7 day, then reduced to 10 mg (1 tablet) taken every other day, stopping on d 17 (n = 11) or placebo (n = 10)	1. Perioperative bleeding 2. Visibility of the operative field 3. Operative time 4. Hospital stay	Perioperative bleeding, operative time and hospital stay were significantly reduced in patients who received oral steroids. Visibility of the operative field was significantly better after receiving steroids
Wright et al.	2007	1b	Prospective double-blind RCT	26 adult CRSwNP patients with surgical indication receiving either 30 mg of prednisone for 5 days preoperatively or placebo	1. Difficulty of surgery 2. Operative time 3. Peroperative blood loss	Surgeons rated the surgery in the placebo-treated group as more difficult than the steroid-treated group No differences were noted in operative duration and blood loss
Günel et al.	2015	1b	Prospective double-blind RCT	65 adult CRSwNP patients with surgical indication receiving either oral prednisolone (1 mg/kg for 2 days and then tapered down, with treatment completed on the day 10) or placebo	1. Intraoperative blood loss 2. Quality of surgical field	No difference in intraoperative blood loos when patients received oral steroids preoperatively Non-significant improvement of quality of surgical field after oral steroids
Fraire et al.	2013	3b	Prospective non-randomized CT	Adult CRS patients with surgical indication (CRSsNP and CSRwNP) receiving either 2×/day 30 mg methylprednisolone on 5 consecutive days prior to surgery (n = 27) vs. no treatment (n = 27)	1. Intraoperative bleeding 2. Surgical time 3. Quality of surgical field	Operative bleeding was significantly reduced in CRSwNP patients who received oral steroids preoperatively. No significance obtained in quality of operating field. No difference in surgical time
Sieskiewicz	2006	1b	RCT	36 adult CRSwNP patients with surgical indication receiving either prednisone (30 mg/day for 5 consecutive days directly before the surgery) or no preoperative treatment	1. Intraoperative bleeding 2. Surgical time 3. Quality of surgical field	Quality of the operating field and surgical time were significantly improved in CRSwNP patients who received oral steroids preoperatively. No significance obtained in total blood loss

RCT randomized controlled trial, CRS chronic rhinosinusitis, CRSwNP chronic rhinosinusitis with nasal polyps