A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis.
OBJECTIVE
To determine if intranasal steroids (INS) are useful in the management of chronic rhinosinusitis without polyps and chronic rhinosinusitis (CRS) with polyps.


METHODS
Studies for inclusion were searched using Medline, EMBASE, Cochrane databases, and references of included studies.


METHODS
Initial screening of article titles and abstracts obtained from the literature search was performed independently by two reviewers (SAJ and RT) based on the research protocol criteria. These articles then underwent a second-stage review. Each article was read in detail and discussed by the two reviewers before inclusion in the study.


RESULTS
The review yielded 13 studies regarding the treatment of sinonasal polyps with intranasal steroids. Six of these could be included in the meta-analysis. The outcome measure used for meta-analysis was change in polyp size from baseline compared between the treatment and control groups. Results from both conservative and optimistic selection of treatment effect are positive, providing significant improvement in polyp size in the treatment group as compared to controls. In the conservative estimate, the mean improvement in polyp size score between the treatment and placebo group is 0.43 with a 95% CI of [0.25, 0.61]. Of those treatment groups with the largest improvement, the mean improvement in polyp size score can go as high as 0.63 with a 95% CI of [0.43, 0.82].


CONCLUSIONS
Intranasal steroids are beneficial in the treatment of chronic rhinosinusitis with sinonasal polyps. Further studies looking at the use of INS in the treatment of CRS without polyps are warranted.
Joe
Stephanie A
SA
Sinus and Nasal Allergy Center, University of Illinois at Chicago, Chicago, IL 60612, USA. sjoe@uic.edu
Thambi
Rakhi
R
Huang
Jie
J
D000281:Administration, Intranasal; D002908:Chronic Disease; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D016896:Treatment Outcome
D005938:Glucocorticoids