Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations

Authors

Devyani Lal, Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
Ameya A. Jategaonkar, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.Follow
Larry Borish, Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA.
Linda R. Chambliss, Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA.
Sharon H. Gnagi, Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
Peter H. Hwang, Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
Matthew A. Rank, Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA.
James A. Stankiewicz, Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
Valerie J. Lund, Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom.

Document Type

Article

Abstract

BACKGROUND: Management of rhinosinusitis during pregnancy requires special considerations. OBJECTIVES: 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. METHODS: The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. RESULTS: Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. CONCLUSIONS: The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.

Medical Subject Headings

Administration, Intranasal; Adrenal Cortex Hormones (therapeutic use); Anti-Bacterial Agents (therapeutic use); Cerebrospinal Fluid Rhinorrhea; Cesarean Section; Chronic Disease; Delivery, Obstetric (methods); Disease Management; Female; Humans; Leukotriene Antagonists (therapeutic use); Nasal Polyps (complications, surgery); Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses (surgery); Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications, Infectious (therapy); Rhinitis (complications, therapy); Sinusitis (complications, therapy)

Publication Date

6-1-2016

Publication Title

Rhinology

ISSN

0300-0729

Volume

54

Issue

2

First Page

99

Last Page

104

PubMed ID

26800862

Digital Object Identifier (DOI)

10.4193/Rhino15.228

Recommended Citation

Lal, Devyani; Jategaonkar, Ameya A.; Borish, Larry; Chambliss, Linda R.; Gnagi, Sharon H.; Hwang, Peter H.; Rank, Matthew A.; Stankiewicz, James A.; and Lund, Valerie J., "Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations" (2016). ENT and Skull Base Surgery. 6.
https://scholar.barrowneuro.org/ent-and-skull-base-surgery/6