(1255) Preoperative Steroid Use in Allergic Fungal Rhinosinusitis: A Scoping Review

Introduction: While the use of perioperative systemic steroids for endoscopic sinus surgery is widely practiced, the role of preoperative medical management with systemic steroids in allergic fungal rhinosinusitis (AFRS) remains poorly defined. In the absence of standardized guidelines, practice patterns are largely anecdotal with limited available evidence. This scoping review aims to characterize the existing literature on the use of pre-operative systemic steroids for AFRS and identify gaps in evidence.

Methods: A scoping review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Embase were searched for studies from inception until January 2025 evaluating preoperative medical management in patients with AFRS. Inclusion criteria included studies describing all patients previously diagnosed with or with high suspicion for AFRS with planned surgical intervention and given pre-operative steroids.

Results: Literature search yielded 441 results across three sources. Following initial screening and full-text review of 36 studies, five studies met inclusion criteria. Included studies consisted primarily of small prospective or retrospective studies and clinician surveys describing the use of oral steroids. Outcome measures varied across studies, with some investigations focusing on surgeon-centered outcomes such as decreased intraoperative bleeding, improved field visualization, and mucosal appearance, while others evaluated disease-specific outcomes such as radiographic findings, patient-reported symptom scores, inflammatory markers, or recurrence rates. Overall, there was no standardized approach for treatment regimens.

Conclusions: AFRS-specific studies addressing preoperative medical management are sparse, and these patients are often excluded from broader chronic rhinosinusitis studies. The heterogeneity of existing literature and lack of sufficient high-quality evidence to support standardized preoperative treatment strategies highlight the need for larger, prospective controlled studies focused specifically on AFRS.