Chinese herbal therapy in the management of rhinosinusitis—A systematic review and meta-analysis

Abstract

This systematic review aims to assess the effects and safety of Chinese herbal medicines (CHMs) in the management of rhinosinusitis (RS); inform clinicians of the current state of the evidence; identify the best available evidence; and suggest further directions for research. Five English and four Chinese language databases, and four clinical trial registries were searched. Eligible studies were randomised controlled trials (RCTs). Participants were diagnosed with RS based on established criteria. Test interventions were CHMs administered orally and/or nasally, excluding injections and displacement techniques. Control interventions included placebos, no additional treatment, and conventional non-invasive treatments including pharmacotherapies and/or nasal irrigation, and/or inhalations. Polyposis and post-surgical recovery were excluded. Outcomes were Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy Endoscopic score (LK), Mucociliary transport time (MTT), Mucociliary transport rate (MTR), quality of life and adverse events (AEs). Risk of bias used the Cochrane tool. Meta-analysis in Review Manager 5.4.1 used random effects for mean difference (MD) or risk ratio (RR) with 95% confidence intervals. Heterogeneity was assessed as I2. Thirty-four RCTs were included, 30 of chronic RS (CRS) and four of acute RS (ARS). These enrolled 3,752 participants. Five RCTs blinded participants. For CRS, comparisons with placebo showed greater improvements in the CHM groups for SNOT-20 and VAS-TNS (total nasal symptoms). Blinded comparisons with pharmacotherapies showed no differences between groups in the degree of improvement for SNOT-20, VAS-TNS, and LM, suggesting these CHMs had similar effects, at least in the short term. In ARS, pooled results found improved scores on VAS-TNS and LK suggesting a benefit for combining these CHMs with pharmacotherapies. Limitations included inadequacies in study design and methodological reporting, and insufficient reporting of AEs. Heterogeneity in some pooled results precluded strong conclusions. Further well-designed studies are needed to test whether the results are replicable. Systematic review registration number: PROSPERO (CRD42019119586).

Orally administered Chinese herbal therapy to assist post-surgical recovery for chronic rhinosinusitis—A systematic review and meta-analysis

“…Hsiao ( huang qi ) ( n = 7). Each of these herbs was a common ingredient in CHM formulae for CRS [ 43 , 76 ]. This suggests that the herbal interventions tested in the RCTs were broadly representative of CHM formulae for CRS.…”

“…In comparison with the results of the systematic review of oral CHMs for RS [ 43 ], BYTQK was used in multiple studies included in both reviews. However, the two most frequent formulae from the earlier review, Bi yuan shu kou fu ye (BYSKFY) and its capsule form Bi yuan shu jiao nang (BYSJN), which were tested in four studies, and Bi dou yan kou fu ye (BDYKFY), which was tested in three studies, did not appear at all as interventions for CRS post-surgery.…”

“…The Chinese guidelines for the diagnosis and treatment of CRS have included Chinese herbal medicines (CHMs) based on syndrome differentiation as additional treatment options [ 32 , 42 ]. The CHMs can be administered orally and/or nasally [ 43 , 44 ].…”

“…A review of various types of herbal medicines for CRS reported improvements in symptoms [ 36 ]. A systematic review of 34 studies of oral and/or nasal CHMs for acute or chronic rhinosinusitis, without surgery, found improvements in symptoms, sinus imaging and measures of mucociliary clearance [ 43 ]. Another systematic review that included 80 randomised controlled trials (RCTs) of herbal medicines for CRS, mostly from China, reported improvements associated with the herbal medicines, but that study combined studies of CRS without surgery and CRS post-surgery [ 45 ].…”