Management of Rhinosinusitis During Pregnancy: Systematic Review and Expert Panel Recommendations
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. === Background: Rhinosinusitis, both acute and chronic, represents a common disease. Approximately 29.6 million adults in the United States...
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| Language: | en_US |
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The University of Arizona.
2016
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| Online Access: | http://hdl.handle.net/10150/603631 http://arizona.openrepository.com/arizona/handle/10150/603631 |
| Summary: | A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. === Background: Rhinosinusitis, both acute and chronic, represents a common disease.
Approximately 29.6 million adults in the United States suffer from sinusitis with 11 million
suffering from CRS1. The multicenter GA2LEN study showed that amongst lifetime nonsmokers,
women were at a greater risk of being affected by chronic rhinosinusitis than men2. Various
other rhinologic manifestations of pregnancy have also been described. Nevertheless,
management of rhinosinusitis during pregnancy is poorly described in the literature.
Objectives:
1. Conduct a systematic review of the literature for the management of acute and chronic
rhinosinusitis (CRS) during pregnancy.
2. Make evidence based recommendations on the management of acute and chronic
rhinosinusitis during pregnancy.
Methods: A systematic review of the literature was conducted using MEDLINE and EMBASE
databases. Search terms included “rhinitis” OR “sinusitis” OR “rhinosinusitis” AND “pregnant”
OR “women” OR “gender”. Title, abstract, and full manuscript review was conducted. Full
manuscripts including citations and references were reviewed if the abstract noted any gender
specific outcomes. A multispecialty panel of experts in the fields of rhinology, allergyimmunology,
and obstetrics‐gynecology was invited to review the systematic review.
Recommendations were sought on the use of the following for the management of CRS during
pregnancy: oral corticosteroids, antibiotics, leukotriene antagonists, topical corticosteroid
sprays/irrigations/drops, aspirin desensitization, elective surgery for CRS, and vaginal birth vs.
planned cesarean delivery for patients with history of skull base erosions or CSF rhinorrhea.
Results: 3052 abstracts were screened, and 88 manuscripts were reviewed. No relevant level 1,
2 or 3 studies were found. Expert panel recommendations were synthesized.
Conclusions: Several recommendations were made. These include continuing all modern
topical corticosteroids for CRS maintenance, using pregnancy safe antibiotics for acute
rhinosinusitis and CRS exacerbations, and discontinuing aspiring therapy for desensitization in
patients with aspirin exacerbated respiratory disease. |
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