2016 Section 5 Green Book

steroid use. Thirty-four of the cases were either decided for the

plaintiff or settled with an average indemnity payment of $1.15

million. A more complete discussion of litigation associated with

steroid use can be found in the review by Poetker and Smith.

USE OF STEROIDS IN CRS

Recently, an iterative review was performed that evaluated the data

that support the use of steroids in patients with CRS.

The research-

ers initially evaluated the data that supported steroids in patients

with CRS and without nasal polyps by identifying four level-4 stud-

ies. Despite the common use of oral steroids for CRS without nasal

polyps, there is no study that evaluated its efficacy as a single agent

for CRS. In fact, there are no high-level studies that support steroid

use even as a component of a multidrug regimen. High-quality stud-

ies are needed to validate efficacy and proper dosing. Given the

potential risks of oral steroids, the expert panel thought that the use

of oral steroid in CRS without polyposis is optional. They indicated

that patients with more severe disease may have a more favorable

benefit-to-harm ratio than patients with mild disease.

When evaluating the use of oral steroids in patients with CRS and

with nasal polyps, 16 articles were identified,

50–65

5 of which had

level-2 evidence.

61–65

All the studies showed positive changes in the

majority of the parameters evaluated. Analysis of the data supports

the use of oral steroids in patients with CRS and with nasal polyps in

the immediate and short-term period. All the studies showed benefit

with very few adverse effects, and no severe adverse events were

reported. The researchers made a strong recommendation for the use

of oral steroids in the management of patients with CRS and with

nasal polyps, provided the use was short term. They further recom-

mended the perioperative use of oral steroids in these patients, based

on two level-2 studies

66,67

and one level-3 study,

which showed

improved visualization during surgery and improved postoperative

courses.

Multiple treatment options exist for CRS, with each option carrying

varying degrees of success in the management of the disease.

One

must keep in mind that all treatment options carry risks. These

include the risks of surgery as well as the risks of antibiotics.

70,71

The

relative risks must be considered, weighed, and discussed. Ulti-

mately, it is the patient who must accept these risks, and it is the

provider’s responsibility to educate the patient by ensuring that an

informed decision is made.

CONCLUSION

In this review, I attempted to provide an overview of the existing

data of the risks of oral steroid use, the lawsuits associated with their

use, and the data that support the use of steroids in the CRS patient

population. No medication or intervention is without risk. Providers

need to be aware of the potential complications and the data that

support the use to provide the best care possible.

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