Devyani Lal1, Ameya A Jategaonkar2, Larry Borish3, Linda R Chambliss4, Sharon H Gnagi1, Peter H Hwang5, Matthew A Rank6, James A Stankiewicz7, Valerie J Lund8. 1. Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA. 2. University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA. 3. Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA. 4. Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA. 5. Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA. 6. Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA. 7. Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA. 8. Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom.
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.
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.
Authors: Vanessa E Murphy; Tamas Zakar; Roger Smith; Warwick B Giles; Peter G Gibson; Vicki L Clifton Journal: J Clin Endocrinol Metab Date: 2002-04 Impact factor: 5.958
Authors: Richard M Rosenfeld; David Andes; Neil Bhattacharyya; Dickson Cheung; Steven Eisenberg; Theodore G Ganiats; Andrea Gelzer; Daniel Hamilos; Richard C Haydon; Patricia A Hudgins; Stacie Jones; Helene J Krouse; Lawrence H Lee; Martin C Mahoney; Bradley F Marple; Col John P Mitchell; Robert Nathan; Richard N Shiffman; Timothy L Smith; David L Witsell Journal: Otolaryngol Head Neck Surg Date: 2007-09 Impact factor: 3.497
Authors: Mitchell P Dombrowski; Michael Schatz; Robert Wise; Elizabeth A Thom; Mark Landon; William Mabie; Roger B Newman; Donald McNellis; John C Hauth; Marshall Lindheimer; Steve N Caritis; Kenneth J Leveno; Paul Meis; Menachem Miodovnik; Ronald J Wapner; Michael W Varner; Mary Jo O'Sullivan; Deborah L Conway Journal: Am J Obstet Gynecol Date: 2004-03 Impact factor: 8.661