Does mometasone nasal spray lead to less postoperative symptoms after endoscopic sinus surgery?
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Background: Many surgeons recommend nasal steroids postoperatively after sinus surgery. The postoperative effects of nasal steroids are poorly documented in the literature. This study was conducted to evaluate if nasal steroids lead to fewer symptoms the first 12 days after surgery and if the nasal steroids show effect on postoperative symptoms and quality of life 3 months after surgery. Methods: This is a randomized controlled trial (RCT), in which 24 patients with chronic rhinosinusitis with (NP) or without nasal polyps (CRS) were randomized to use either mometasone nasal spray or placebo postoperatively for 3 months. Twelve patients (7 had NP and 5 had CRS) used mometasone nasal spray postoperatively and twelve patients (4 had NP and 8 had CRS) used a placebo nasal spray. All patients reported symptoms as headache, facial pain and nasal blockage on a visual analogue scale (VAS) daily in a diary the first 12 postoperative days. The use of painkillers and postoperative bleeding were also reported. Additionally, we compared the change in nasal symptoms on VAS and quality of life, using the Rhinoconjuctivitis Quality of Life Questionnaire (RQLQ), from preoperatively to 3 months postoperatively in the two groups. Results: The diary showed significantly more headache and facial pain in the mometasone group (P<0.05) the first three days after surgery compared to the placebo group. The mometasone group used more analgesics postoperatively (P<0.001) and was more troubled with nasal congestion from day 5 to day 11 postoperatively (P<0.001) than the placebo group. Less nasal bleeding was registered the first 10 days after surgery in the mometasone group. Both groups showed a significant improvement in quality of life (P<0.05) and also symptoms as nasal congestion, headache, facial pain, sneezing, nasal discharge and general health improved significantly in both groups. Conclusion: This RCT must be regarded as a pilot study. The number of patients is low in both groups and the groups are heterogeneous. The postoperative diary indicates more discomfort in the mometasone group than the placebo group. Quality of life and symptoms improved significantly in both groups after surgery. However the validity of the results remains uncertain and cannot be used as clinical evidence; the results have to be controlled in a larger trial with more patients in more homogeneous groups.