Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations
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)
Digital Object Identifier (DOI)
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.