Topical steroids in chronic rhinosinusitis without polyps: a systematic review and meta-analysis.
OBJECTIVE
To evaluate whether topical steroids provide symptomatic relief in patients with chronic rhinosinusitis without polyps.


METHODS
MEDLINE, EMBASE, and Cochrane CENTRAL databases.


METHODS
Systematic review and meta-analysis was performed of the articles identified by two independent reviewers of all randomized controlled trials that had evaluated intranasal corticosteroids in patients with chronic rhinosinusitis (CRS) without polyps. The quality of included studies was evaluated, and results synthesized using standard random-effects meta-analytical methods.


RESULTS
Of 424 potential studies, only nine randomized trials involving 657 patients in total were eligible. Quality of design and reporting was suboptimal, with only one trial adhering to accepted standards for reporting. Five trials combined outcome measures and reported on overall response of CRS without polyps to topical steroids. The summary estimate for overall response to treatment showed no significant benefit and substantial variability among studies (5 trials: RR 0.75, 95% CI 0.50-1.10, P = 0.14, chi(2) = 13.78, I(2) = 66.2%). Total symptom score was reported in three trials with a standardized mean difference favoring topical steroids (RR 0.63, 95% CI 0.16-1.09, P = 0.009), with no evidence of heterogeneity (chi(2) = 3.03, P = 0.22). Although the data were limited, there were no reports of increased adverse effects with topical steroids.


CONCLUSIONS
There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without polyps; however, their use appears safe and may show some symptomatic benefit. A class effect among different topical steroids cannot be assumed, and further trials are required.
Kalish
Larry H
LH
Department of Otorhinolaryngology, Concord Repatriation Hospital, Sydney, New South Wales, Australia. lhkalish@mac.com
Arendts
Glenn
G
Sacks
Raymond
R
Craig
Jonathan C
JC
D000287:Administration, Topical; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*
D005938:Glucocorticoids