title: Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations.
abstract: BACKGROUND
  Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS.
  
  
  METHODS
  A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review.
  
  
  RESULTS
  This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations).
  
  
  CONCLUSIONS
  Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).
authors.affiliation: Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada. lukerudmik@gmail.com
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Monica
authors.initials: M
authors.lastname: Hoy
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Welch
authors.forename: Valerie
authors.initials: V
authors.lastname: Lund
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D000529:Complementary Therapies; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D007507:Therapeutic Irrigation
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents