TỔNG QUAN LUẬN ĐIỂM VỀ RỬA MŨI BẰNG CORTICOID SAU PHẪU THUẬT NỘI SOI MŨI XOANG Ở BỆNH NHÂN VIÊM MŨI XOANG MẠN TÍNH

Abstract

Introduction: Chronic rhinosinusitis (CRS) is a prevalent disease, affecting 5–12% of the general population and significantly impairing patients’ quality of life. When medical management fails, functional endoscopic sinus surgery (FESS) is indicated; however, postoperative outcomes largely depend on adequate postsurgical care. The use of topical corticosteroids delivered via high-volume nasal irrigation after surgery has demonstrated potential in controlling mucosal inflammation and preventing disease recurrence. Nevertheless, this method has not yet received official approval from the FDA, and evidence regarding its long-term safety and clinical efficacy remains incomplete, particularly in Vietnam. This study was conducted to systematically review the efficacy and safety of corticosteroid nasal irrigation after FESS in patients with CRS. Objective: To describe the efficacy and safety profile of this intervention. Method: This is a scoping review conducted in accordance with the PRISMA guidelines. A systematic search was performed across PubMed, the Cochrane Library, Rhinology Journal, and Hanoi Medical University Digital Library, covering the period from 2010 to 2025. The inclusion criteria were studies investigating high-volume corticosteroid nasal irrigation following FESS for the treatment of CRS. Exclusion criteria included systematic reviews, meta‑analyses, theses, and case reports. A total of 20 studies (894 patients) were included in the analysis. Results: The majority of studies demonstrated that corticosteroid nasal irrigation resulted in significantly greater improvements in SNOT‑22 and LKES scores compared to saline irrigation alone (6/7 studies) and compared to corticosteroid nasal sprays (3/4 studies). Regarding safety, short‑term use (≤3 months) did not cause hypothalamic‑pituitary‑adrenal (HPA) axis suppression. Long‑term use (>12 months) was associated with subclinical HPA axis suppression in 23% of patients (Soudry 2016), particularly when combined with inhaled corticosteroids for asthma (OR = 30.4). No clinically significant changes in intraocular pressure were observed. The retained dose of budesonide after irrigation was 37.9% of the initial dose. Conclusion: Corticosteroid nasal irrigation after endoscopic sinus surgery improves quality of life and endoscopic scores, particularly in patients with nasal polyps or eosinophilic chronic rhinosinusitis, while not causing clinically significant elevation of intraocular pressure. Caution and monitoring for HPA axis suppression are warranted in patients using concomitant corticosteroids via other routes (e.g., inhaled corticosteroids for asthma). Treatment should be individualized based on disease phenotype, comorbidities, and total corticosteroid load.