{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:59:09Z","timestamp":1790852349054,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2019R1F1A1057975"],"award-info":[{"award-number":["NRF-2019R1F1A1057975"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["NRF-2019R1F1A1057975"],"award-info":[{"award-number":["NRF-2019R1F1A1057975"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Ministry of Trade, Industry & Energy (MOTIE) of Korea","award":["RS-2026-25524542"],"award-info":[{"award-number":["RS-2026-25524542"]}],"id":[{"id":"https:\/\/ror.org\/008nkqk13","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: Budesonide irrigation (BI) has emerged as an effective postoperative topical therapy for chronic rhinosinusitis (CRS), providing improved drug delivery compared with conventional intranasal corticosteroid sprays. However, evidence regarding its role as a maintenance strategy during the critical postoperative period remains limited. This study aimed to evaluate the clinical efficacy of BI compared with saline irrigation (SI) in patients with persistent symptoms following functional endoscopic sinus surgery (FESS) and to determine whether treatment effects differed according to CRS inflammatory endotypes. Methods: This retrospective cohort study included 121 patients with CRS who underwent FESS between 2021 and 2024. Patients with persistent symptoms 3 months post-operation were treated with either continued SI (n = 54) or BI (n = 67) for at least 6 months. Clinical outcomes included changes in SNOT-22 scores, modified Lund\u2013Kennedy endoscopic scores (mLKS), olfactory function assessed by KVSS II, oral corticosteroid (CS) use, and disease control status. Subgroup analyses were conducted for eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS). Results: The BI group showed significantly greater improvement in total SNOT-22 scores than the SI group (p &lt; 0.0001), particularly in rhinological symptoms. Endoscopic outcomes also favored BI, with greater reductions in total mLKS and mucosal edema scores. These benefits were observed in both ECRS and NECRS, although objective endoscopic improvements were more pronounced in ECRS. Patients receiving BI required fewer courses of oral CS (18.42% vs. 52.38%, p = 0.01) and demonstrated better disease control (p = 0.03). However, no significant difference was observed in olfactory function. Conclusions: BI provides superior symptom improvement, better endoscopic healing, and reduced oral CS use compared with SI during postoperative CRS maintenance, supporting its use in both ECRS and non-ECRS subgroups.<\/jats:p>","DOI":"10.3390\/jcm15197617","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:25:44Z","timestamp":1790850344000},"page":"7617","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic Value of Budesonide Nasal Irrigation for Postoperative Maintenance of Chronic Rhinosinusitis: A Real-World Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Soo Yeon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Jin-Young","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1111\/j.1398-9995.2011.02646.x","article-title":"Chronic rhinosinusitis in Europe\u2014An underestimated disease. A GA(2)LEN study","volume":"66","author":"Hastan","year":"2011","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.jaci.2018.03.004","article-title":"Endotype-driven care pathways in patients with chronic rhinosinusitis","volume":"141","author":"Bachert","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.jaci.2011.07.049","article-title":"Pathogenesis of chronic rhinosinusitis: Inflammation","volume":"128","author":"Zhang","year":"2011","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","first-page":"CD006394","article-title":"Nasal saline irrigations for the symptoms of chronic rhinosinusitis","volume":"3","author":"Harvey","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"437","DOI":"10.4168\/aair.2023.15.4.437","article-title":"Inflammatory Endotypes of Chronic Rhinosinusitis in the Korean Population: Distinct Expression of Type 3 Inflammation","volume":"15","author":"Min","year":"2023","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1002\/alr.22093","article-title":"Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery","volume":"8","author":"Harvey","year":"2018","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_8","first-page":"130","article-title":"Budesonide nasal irrigation for chronic rhinosinusitis: A meta-analysis of therapeutic outcomes and safety profile","volume":"63","author":"Magboul","year":"2025","journal-title":"Rhinology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s00405-019-05327-6","article-title":"Budesonide nasal irrigation improved Lund-Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery","volume":"276","author":"Huang","year":"2019","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1002\/alr.21189","article-title":"Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis","volume":"3","author":"Jang","year":"2013","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_11","first-page":"346","article-title":"Effect of budesonide nasal irrigation on Hypothalamic-Pituitary-Adrenal Axis in patients with chronic rhinosinusitis post endoscopic sinus surgery: A prospective study","volume":"43","author":"Kanjanaumporn","year":"2025","journal-title":"Asian Pac. J. Allergy Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/alr.23232","article-title":"Adverse events associated with budesonide nasal irrigation reported to the US Food and Drug Administration: 2007 to 2022","volume":"14","author":"Rathi","year":"2024","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jung, S.M., Kwak, J.H., Kim, M.K., Tae, K., Cho, S.H., and Jeong, J.H. (2022). The Long-Term Effects of Budesonide Nasal Irrigation in Chronic Rhinosinusitis with Asthma. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102690"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1042\/cs0940557","article-title":"Anti-inflammatory actions of glucocorticoids: Molecular mechanisms","volume":"94","author":"Barnes","year":"1998","journal-title":"Clin. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"317","DOI":"10.21053\/ceo.2024.00233","article-title":"Therapeutic Effectiveness of SNOT 22-Based Interdose Interval Adjustment of Dupilumab for Chronic Rhinosinusitis with Nasal Polyps","volume":"17","author":"Yoon","year":"2024","journal-title":"Clin. Exp. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jaci.2020.11.013","article-title":"EUFOREA expert board meeting on uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) and biologics: Definitions and management","volume":"147","author":"Bachert","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/all.12644","article-title":"Novel scoring system and algorithm for classifying chronic rhinosinusitis: The JESREC Study","volume":"70","author":"Tokunaga","year":"2015","journal-title":"Allergy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1002\/alr.22025","article-title":"A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis","volume":"7","author":"Feng","year":"2017","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/19458924241269786","article-title":"The Evaluation Value of the Modified Lund-Kennedy Nasal Endoscopy Score on the Efficacy of Sublingual Immunotherapy for Allergic Rhinitis","volume":"38","author":"Zhang","year":"2024","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1016\/S0194-5998(97)70005-6","article-title":"Staging for rhinosinusitis","volume":"117","author":"Lund","year":"1997","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11882-025-01223-8","article-title":"The ARIA(R) guidelines and the EUFOREA non-evidence-based algorithm cannot be compared and embedded in an integrated approach","volume":"25","author":"Bousquet","year":"2025","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1002\/alr.22741","article-title":"International consensus statement on allergy and rhinology: Rhinosinusitis 2021","volume":"11","author":"Orlandi","year":"2021","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1002\/alr.21047","article-title":"Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis","volume":"2","author":"Snidvongs","year":"2012","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1002\/alr.70112","article-title":"Effect of Budesonide Nasal Irrigation in Patients with Chronic Rhinosinusitis with Nasal Polyps Without Prior Sinus Surgery: A Randomized, Double-Blind, Placebo-Controlled Study","volume":"16","author":"Pontes","year":"2026","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"91","DOI":"10.21053\/ceo.2016.00220","article-title":"The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis with Asthma","volume":"10","author":"Kang","year":"2017","journal-title":"Clin. Exp. Otorhinolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s12070-021-02509-9","article-title":"Efficacy of Topical High Volume Budesonide Nasal Irrigation in Post FESS Patients of Chronic Rhinosinusitis with or Without Nasal Polyposis","volume":"74","author":"Kothiwala","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1001\/jama.2015.7544","article-title":"Medical Therapies for Adult Chronic Sinusitis: A Systematic Review","volume":"314","author":"Rudmik","year":"2015","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1002\/alr.21724","article-title":"Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery","volume":"6","author":"Soudry","year":"2016","journal-title":"Int. Forum Allergy Rhinol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7617\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:37:27Z","timestamp":1790851047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":28,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197617"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197617","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}