Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta-analysis.
Int Forum Allergy Rhinol
; 2024 May 24.
Article
en En
| MEDLINE
| ID: mdl-38787291
ABSTRACT
BACKGROUND:
Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature.METHODS:
Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio).RESULTS:
Ten trials (N = 751) were included for meta-analysis, with a mean age of 47.5 years (range 18-80 years; 95% confidence interval [CI] 43.9-51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI 0.3-0.6; p < 0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI 0.1-0.7; p = 0.01), but not with topical spray (Δ0.04; 95% CI -0.9 to 1.0; p = 0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR] 3.4; 95% CI 1.9-6.0; p < 0.0001; OR 12.4; 95% CI 1.8-83.8; p < 0.01), whereas patients treated with topical spray had no significant difference (OR 1.8; 95% CI 0.9-4.0; p = 0.12).CONCLUSIONS:
Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.
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Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
Int Forum Allergy Rhinol
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos