Effect of Intranasal Corticosteroids on Secondary Sinonasal Symptoms: A Systematic Review of Randomized Trials

Abstract

Background Intranasal corticosteroid (INCS) sprays are indicated for use in the treatment of seasonal and perennial allergic rhinitis and include aqueous and nonaqueous formulations. Secondary symptoms of rhinitis include postnasal drip, facial pain/pressure, headache, cough, and ear fullness. The effectiveness of INCS on these specific symptoms, as well as the comparative effectiveness of aqueous and nonaqueous formulations, is poorly defined. Objective To evaluate the effectiveness of aqueous versus nonaqueous INCS formulations on less common sinonasal symptoms. Methods A systematic review was conducted of English-language, randomized controlled trials, with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard. Studies that did not provide quantitative data on relief of postnasal drip, facial pain/pressure, headache, cough, and ear fullness were excluded. An itemized assessment of the risk of bias was conducted for each included study. Results Of the 118 studies identified, 9 met the criteria for qualitative analysis. An effect on postnasal drip was reported in 5 studies, facial pain/pressure in 2 studies, and cough in 2 studies. A reduction in a specific symptom was reported in about half of these studies, with heterogenous outcome measures. Only 1 study reported the effect of a nonaqueous formulation on a specific symptom. No studies reported an effect on aural fullness. Conclusions Limited data are available regarding the effectiveness of aqueous or nonaqueous INCS on secondary symptoms in adult patients with rhinitis. Further study is needed using homogenous outcome measures and direct comparison of INCS formulations.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…It is not clear if treatment of AR with INCS improves the associated cough, 3245,3250 but an RCT by Kim et al 3245 . suggests that nasal saline irrigations decrease cough associated with AR.…”

Update in Rhinology and Allergy

“…Deot et al reviewed the effect of intranasal corticosteroids, aqueous versus nonaqueous formulations, on secondary sinonasal symptoms including cough, postnasal drip, facial pain/pressure, headache, and ear fullness. 7 Although in theory, nonaqueous formulations should have better drug delivery to more distal regions of the nasal cavity, despite an extensive literature search, there was very limited data comparing aqueous to nonaqueous formulations, indicating this is an area that still requires further investigation. Another form of topical steroids, mometasone furoate sinus implants, provided significant improvements in outcomes including nasal obstruction/ congestion score, bilateral polyp grade, and ethmoid sinus obstruction and potentially less need for surgical revision compared to mometasone furoate nasal spray in patients with CRS with nasal polyps.…”