Which treatments are safe and effective for chronic sinusitis?

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Clinical Inquiries

Which treatments are safe and effective for chronic sinusitis?

J Fam Pract. 2016 November;65(11):829-831

By

Darrell R. Over, MD, MSc

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References

1. Kalish L, Snidvongs K, Sivasubramaniam R, et al. Topical steroids for nasal polyps. Cochrane Database Syst Rev. 2012;(12):CD006549.

2. Snidvongs K, Kalish L, Sacks R, et al. Topical steroids for chronic rhinosinusitis without polyps. Cochrane Database Syst Rev. 2011;(8):CD009274.

3. Harvey R, Hannan SA, Badia L, et al. Nasal saline irrigation for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;(3):CD006394.

4. Pynnonen MA, Venkatraman G, Davis GE. Macrolide therapy for chronic rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. 2013;148:366-373.

5. Chester AC, Antisdel JL, Sindwani R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg. 2009;140:633-639.

6. Rimmer J, Fokkens W, Chong LY, et al. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev. 2014;(12):CD0069991.

EVIDENCE-BASED ANSWER:

For adults with chronic rhinosinusitis (CRS), intranasal steroid (INS) therapy is more likely than placebo to improve symptoms (50% vs 32%; strength of recommendation [SOR]: A, systematic reviews).

Nasal saline irrigation (SI) alleviates symptoms better than no therapy (SOR: A, systematic reviews), but it’s probably not as effective as INS treatment (SOR: B, randomized controlled trial [RCT] with wide confidence interval).

Long-term (12 weeks) macrolide therapy doesn’t alter patient-oriented quality-of-life measures (SOR: A, systematic reviews).

Endoscopic sinus surgery improves CRS symptoms—nasal obstruction, discharge, and facial pain—over baseline (SOR: A, systematic reviews). Surgery and medical therapy appear about equivalent in terms of symptom improvement and quality-of-life measures (SOR: B, systematic reviews of low-quality RCTs).

EVIDENCE SUMMARY

The TABLE^1-4 shows the major results of the meta-analyses for the various medical therapy trials.

Two systematic reviews with meta-analyses evaluated treatment with INS for CRS with nasal polyps (40 RCTs; 3624 patients, mean age 48 years, 64% male) and without polyps (10 RCTs; 590 patients, mean age 39 years, 51% male).^1,2 Trials reported sinonasal symptom outcomes differently and couldn’t be combined. In addition to reducing rate of polyp occurrence, for both CRS with and without polyps, key findings were:

Global symptom scores were better for INS than placebo.
Proportion of patients responding was greater for INS than with placebo.

There was no significant difference between adverse event rates with INS and placebo.

A systematic review and meta-analysis (8 RCTs, 389 patients) compared different SI regimens for CRS.³The standardized mean difference was used to combine trials using various symptom outcomes. Key findings included the following:

SI was better than no treatment.
SI adjunctive therapy (with an antihistamine) improved disease-specific quality-of-life scores.
SI was less effective than INS therapy for symptom improvement.

Hypertonic and isotonic saline yielded similar symptom scores. No adverse effects were reported.

Evidence-based answers from the Family Physicians Inquiries Network

Which treatments are safe and effective for chronic sinusitis?

References

EVIDENCE SUMMARY

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