Topical steroid for chronic rhinosinusitis without polyps
Abstract
Background
Topical corticosteroid is used as part of a comprehensive medical treatment for chronic rhinosinusitis (CRS) without polyps. Nevertheless, there is insufficient evidence to show a clear overall benefit. Trials studying the efficacy of topical corticosteroid use various delivery methods in patients who have or have not had sinus surgery, which directly impacts on topical delivery and distribution.
Objectives
To assess the effects of topical steroid in patients with CRS without nasal polyps and perform a meta‐analysis of symptom improvement data, including subgroup analysis by sinus surgery status and topical delivery methods.
Search methods
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 9 July 2010.
Selection criteria
All randomised trials in which a topically administered corticosteroid was compared with either a placebo, no treatment or alternative topically administered corticosteroid for the treatment of CRS without polyps in patients of any age.
Data collection and analysis
Two authors reviewed the search results and selected trials meeting the eligibility criteria, obtaining full texts and contacting authors where necessary. We documented our justification for the exclusion of studies. Two authors extracted data using a pre‐determined standardised data form.
Main results
Ten studies (590 patients) met the inclusion criteria. The trials were of low (six trials) and medium (four trials) risk of bias. The primary outcome was sino‐nasal symptoms. When compared to placebo, topical steroid improved symptom scores (standardised mean difference ‐0.37; 95% confidence interval (CI) ‐0.60 to ‐0.13, P = 0.002; five trials, n = 286) and had a greater proportion of responders (risk ratio 1.69; 95% CI 1.21 to 2.37, P = 0.002; four trials, n = 263). With a limited number of studies, the subgroup analyses of patients who had received sinus surgery versus those who had not was not significant (P = 0.35). Subgroup analyses by topical delivery method revealed more benefit when steroid was administered directly to the sinuses than with simple nasal delivery (P = 0.04). There were no differences between groups for quality of life and adverse events.
Authors' conclusions
Topical steroid is a beneficial treatment for CRS without polyps and the adverse effects are minor. It may be included in a comprehensive treatment of CRS without polyps. Direct delivery of steroid to the sinuses may bring more beneficial effect. Further studies comparing different topical drug delivery methods to the sinuses, with appropriate treatment duration (longer than 12 weeks), are required.
Plain language summary
Topical steroid for chronic rhinosinusitis without polyps
For chronic rhinosinusitis (without polyps), topical steroid improves symptom control. This review summarises the evidence on the effects of steroid being delivered up the nose (topical delivery) in the management of chronic rhinosinusitis. We included 10 studies in the review, with a total of 590 patients. The evidence shows that topical steroid is beneficial in the treatment of chronic rhinosinusitis without polyps. When we combined data from studies, the evidence favoured topical steroid compared to placebo for control of symptoms. A greater proportion of topical steroid‐treated patients also responded to treatment. Methods of administration which allow direct delivery of steroid to the sinuses may be key to the beneficial effect compared to simple sprays or drops up the nose. When compared to placebo, there was no difference in reported side effects. Direct comparison of delivery techniques in future studies may be useful.
