22
Treatment
Table 8. Evidence for Postoperative Care Following ESS
for CRS
Intervention Grade Benefit Harm
Saline
Irrigations
B Well-tolerated. Improved
symptoms and endoscopic
appearance
Local irritation,
ear symptoms
Sinus Cavity
Debridements
B Improved symptoms and
endoscopic appearance.
Reduced risk of synechia
and turbinate lateralization
Inconvenience, pain, epistaxis,
syncope, and mucosal injury.
Topical
Corticosteroids
A Improved symptoms and
endoscopic appearance.
Reduced recurrence rate
of polyps
Epistaxis, headache
Oral Antibiotics B Improved symptoms and
endoscopic appearance.
Reduced crusting
GI upset, colitis, anaphylaxis,
bacterial resistance
Topical
Decongestants
N/A Potential reduced mucosal
swelling and bleeding
Increased pain, possible
rhinitis medicamentosa
Systemic
Corticosteroids
C Improvement in
endoscopic appearance,
reduction in polyp
recurrence
Insomnia, mood changes,
hyperglycemia, gastritis,
increased intraocular pressure,
avascular necrosis
Mitomycin C B Reduction in synechia
formation, improvement
in maxillary ostium
patency
Off-label use, systemic
absorption, local toxicity
Postoperative
Packing
A Potential reduction in
postoperative adhesion
and improved ostial size
with some materials
Potential for increased
discomfort in situ and on
removal. Rare risk of toxic
shock syndrome. Potential for
an increased rate of adhesions
with some materials
Postoperative
Drug-eluting
Implants
A Reduction in polyposis
and adhesions which
translates into a reduction
in postoperative
interventions
Potential for misplacement
and local reaction
