Impact of Topical Corticosteroid Nasal Irrigation on Postoperative Endoscopic Healing following Functional Endoscopic Sinus Surgery: A Randomized Controlled Study Using Lund–Kennedy Endoscopic Scores

Background:Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the nasal cavity and paranasal sinuses that frequently requires functional endoscopic sinus surgery (FESS) when medical therapy fails. Postoperative nasal irrigation is widely recommended to promote mucosal healing and reduce inflammatory debris. The addition of topical corticosteroids such as budesonide to saline irrigation may enhance anti-inflammatory effects and improve postoperative outcomes.Purpose:To evaluate whether budesonide nasal irrigation provides superior postoperative endoscopic healing compared with normal saline irrigation following FESS in patients with CRS.Methods:This prospective randomized controlled study included 60 adult patients with CRS undergoing FESS. Participants were randomly assigned to two groups (n = 30 each). Group A received budesonide nasal irrigation (1 mg budesonide mixed in 400 mL saline) twice daily, while Group B received isotonic saline irrigation alone for 10 weeks postoperatively. Endoscopic outcomes were evaluated using the Lund–Kennedy (LK) scoring system at baseline and at 2, 6, and 12 weeks after surgery. Statistical analysis included repeated-measures ANOVA and intergroup comparisons.Results:Both groups demonstrated significant improvement in LK scores over time (p < 0.001). However, the budesonide group showed significantly greater improvement compared with the saline group at 2 weeks (6.18 ± 1.02 vs 7.01 ± 1.11; p = 0.004), 6 weeks (3.94 ± 0.88 vs 5.26 ± 1.03; p < 0.001), and 12 weeks (1.82 ± 0.74 vs 3.47 ± 0.96; p < 0.001). Significant reductions in edema, crusting, and nasal discharge were also observed. The mean difference in LK score at 12 weeks was 1.65 (95% CI: 1.12–2.18) with a large effect size (Cohen’s d = 1.82).Conclusion:Budesonide nasal irrigation significantly enhances postoperative mucosal healing following FESS compared with saline irrigation alone. Incorporating corticosteroid irrigation into postoperative management may improve endoscopic outcomes in patients with CRS.