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The role of adjuvant systemic steroids in the management of periorbital cellulitis secondary to sinusitis: a systematic review and meta-analysis

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Abstract

Purpose

The role of adjuvant systemic corticosteroids in the management of periorbital cellulitis and subperiosteal/orbital abscesses secondary to sinonasal infections is not well understood. Our objective was to systematically review the current evidence on the efficacy and side effects of systemic steroids when used in the management of periorbital cellulitis.

Methodology

A systematic review of literature was conducted in accordance with PRISMA guidance. A systematic search of MEDLINE, Embase and Cochrane databases, MetaRegister and ISI conference proceedings was conducted. The outcomes of interest were duration of inpatient stay, requirement for surgical intervention, adverse effects and recurrent/residual symptoms.

Results

Four studies were identified involving 118 patients. Of these, 78 underwent treatment with systemic corticosteroids and 40 were controls. Meta-analysis demonstrated that the mean duration of inpatient stay was significantly shorter in the steroid group (WMD − 2.90 days; 95% CI − 3.07, − 2.73; p < 0.00001). There were no significant differences in requirement for surgical intervention (RR 0.93; 95% CI 0.50, 1.75; p = 0.83). Side effects were reported in 6/78 patients (7.7%), with 5 patients showing signs of hyperactivity and 1 patient with insomnia. These were mild except in one case, which required early cessation of corticosteroids. There was one case of recurrence of symptoms in each cohort (steroid vs. non-steroid) following discharge.

Conclusions

The evidence suggests that systemic corticosteroids may offer some benefit in the management of periorbital cellulitis secondary to sinonasal infections. However, there is significant heterogeneity and risk of bias. A well-designed randomised controlled trial may provide a better insight into the efficacy of systemic steroids for this condition.

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Acknowledgements

The authors would like to thank the help of Mr Mark Kerr (East Kent Hospitals NHS Trust Library) for his support with the literature search.

Funding

None to declare.

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Authors and Affiliations

  1. Department of Otolaryngology, Brighton and Sussex University, Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK

    Sridhayan Mahalingam

  2. Department of Otolaryngology, East Kent University Foundation Trust, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK

    Louis Luke

  3. Centre for Reproductive Medicine, St Bartholomew’s Hospital, London, UK

    Jyotsna Pundir

  4. Department of Otolaryngology, Maidstone and Tunbridge Wells NHS Trust, Royal Tunbridge Wells, UK

    Vishal Pundir

Authors
  1. Sridhayan Mahalingam
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  2. Louis Luke
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  4. Vishal Pundir
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Contributions

All authors contributed to the study conception and design. SM, LL and VP performed literature searches and data extraction. VP and JP performed data analysis. SM wrote the first draft of the manuscript and VP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sridhayan Mahalingam.

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Mahalingam, S., Luke, L., Pundir, J. et al. The role of adjuvant systemic steroids in the management of periorbital cellulitis secondary to sinusitis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 278, 2193–2201 (2021). https://doi.org/10.1007/s00405-020-06294-z

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  • DOI: https://doi.org/10.1007/s00405-020-06294-z

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