Use of Nasal Steroid Sprays after Functional Endoscopic Sinus Surgery (FESS): Do They Really Help?

Background: Functional Endoscopic Sinus Surgery (FESS) is an established intervention for chronic rhinosinusitis, yet postoperative inflammation, mucosal edema, and recurrence continue to affect long-term outcomes. Intranasal corticosteroids are routinely used after surgery to support mucosal healing, reduce inflammation, and maintain sinus patency. Ongoing variability in delivery methods has raised important questions regarding optimal postoperative therapy.
Objective: This study aimed to review and evaluate current evidence on the effectiveness, delivery techniques, safety, and clinical outcomes of intranasal corticosteroid therapies following FESS.
Methods: We have searched PubMed, Scopus, and the Cochrane Library for randomized controlled trials, meta-analyses, and comparative studies examining postoperative corticosteroid use after FESS. We have also reviewed international clinical guidelines (EPOS 2020, AAO-HNS) and manually screened high-impact otolaryngology journals for additional relevant evidence. Comparisons among nasal sprays, corticosteroid irrigations and steroid-eluting implants were analyzed with focus on symptom relief, endoscopic healing, recurrence reduction, quality-of-life improvement and safety. Documents written in languages other than English have been ignored. Papers that were not regarded as significant scientific research included dissertations, oral presentations, conference abstracts and unpublished manuscripts were excluded.
Conclusion: Intranasal corticosteroids remain a cornerstone of postoperative care after FESS, consistently improving mucosal healing, reducing inflammation and lowering recurrence risk with excellent safety. While conventional sprays are effective for routine maintenance, high-volume steroid irrigations and steroid-eluting implants provide deeper sinus penetration and offer added benefit for patients with extensive disease. Future work should aim to standardize dosing strategies and tailor postoperative therapy based on disease phenotype and surgical extent.