Perioperative Use of Systemic Steroids Within Otolaryngology-Head and Neck Surgery: Evidence-Based Guidance for Clinicians

Allison K Ikeda; Raluca Gray; Victoria Lee; James Dixon Johns; Selena Briggs; Nikhila R Raol; Uchechukwu C Megwalu; Stephanie Joe; Frank Garritano; Michael J Brenner; Edward D McCoul

doi:10.1002/ohn.1067

Perioperative Use of Systemic Steroids Within Otolaryngology-Head and Neck Surgery: Evidence-Based Guidance for Clinicians

Otolaryngol Head Neck Surg. 2024 Dec 3. doi: 10.1002/ohn.1067. Online ahead of print.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, District of Columbia, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
⁷ Department of Head and Neck Surgery, The Permanente Medical Group, Union City, California, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁹ Department of Otorhinolaryngology, Ochsner Health, New Orleans, Louisiana, USA.

PMID: 39624920
DOI: 10.1002/ohn.1067

Abstract

Objective: To review and synthesize the available evidence for use of perioperative systemic steroids for otolaryngologic surgical procedures.

Data sources: A comprehensive literature review with evidence-informed recommendations.

Review methods: Databases were queried for medical subject heading terms and keywords related to perioperative systemic corticosteroids use for comprehensive otolaryngology and subspecialty procedures including otologic, sinonasal, sleep, laryngeal, head and neck, facial plastics, and pediatric surgery. Perioperative period included preoperative (up to 7 days prior to surgery), intraoperative (on the day of surgery), and postoperative (initiated within 24 hours after surgery) timeframes.

Conclusions: Evidence from clinical practice guidelines, systematic reviews, and original research studies supports perioperative systemic corticosteroid use for specific otolaryngologic indications. Numerous studies support perioperative steroid use for nausea, vomiting, or edema in tonsillectomy, rhinoplasty, and thyroidectomy, although formal guideline recommendations are limited. Strong evidence supports perioperative steroid use before and after endoscopic sinus surgery for chronic rhinosinusitis with polyposis and fungal sinusitis. Evidence of benefit is sparse or absent on systemic perioperative steroid use for the middle and inner ear, laryngeal, salivary gland surgery, and reconstructive facial plastic surgery.

Implications for practice: Although perioperative administration of systemic steroids is routinely performed for many otolaryngologic surgeries, high-level evidence is limited to specific contexts. Evidence supports the benefit for reducing nausea, vomiting, or edema for several otolaryngologic procedures, as well as for either chronic rhinosinusitis with polyposis or fungal sinusitis. However, these benefits need to be weighed against risks, and further investigations are needed to define the role for perioperative steroids in otolaryngology.

Keywords: evidence; guidelines; intraoperative steroids; meta‐analysis; otolaryngology–head and neck surgery; perioperative steroids; postoperative steroids; preoperative steroids; randomized clinical trial; systematic review; systemic corticosteroids; systemic steroids.