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. DATA SOURCES: Studies for inclusion were searched using Medline, EMBASE, Cochrane databases, and references of included studies. REVIEW 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 hi-h as 0.63 with a 95% CI of [0.43 0.82]. CONCLUSION: 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. (c) 2008 American Academy of Otolarynoology-Head and Neck Surgery Foundation. All rights reserved.