Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis

Chong, Lee Yee; Head, Karen; Hopkins, Claire; Philpott, Carl; Schilder, Anne G. M.; Burton, Martin J

doi:10.1002/14651858.cd011996.pub2

Cited by 138 publications

(120 citation statements)

References 92 publications

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“…Topical steroid sprays and steroid nasal rinses are also known to be more effective after endoscopic sinus surgery [45–47]. For moderate symptoms, oral corticosteroids are also indicated for the treatment of CRSwNP and have been shown in randomized, placebo-controlled trials to decreased nasal symptoms, and polyp size when taken in moderate doses [48].…”

Section: Medical Treatment Optionsmentioning

confidence: 99%

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

Vickery

Ramakrishnan²,

Suh

2019

Curr Allergy Asthma Rep

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Purpose of Review Staphylococcus aureus (S. aureus) is correlated with the development of persistent severe inflammatory disease of the upper airway including chronic rhinosinusitis with nasal polyps (CRSwNP). The presence of S. aureus is associated with atopic disease including allergic rhinitis and atopic dermatitis and is associated with poor outcomes. Recent Findings Several different strains of S. aureus generate different toxins and gene products that can account for organism pathogenicity. S. aureus bacteria and its antigens shape the bacterial and fungal microbiome and the mucosal niche which generates host responses that can account for inflammation. The multiple disease phenotypes and molecular endotypes seen in CRSwNP can be characterized by T-helper cell environment within the inflammatory milieu, the presence of epithelial barrier dysfunction, aberrant eicosanoid metabolism, poor wound healing, and dysfunctional host-bacteria interactions which lead to recalcitrant disease and worse surgical outcomes. Summary Understanding the pathomechanisms that S. aureus utilizes to promote nasal polyp formation, prolonged tissue inflammation, and bacterial dysbiosis are essential in our efforts to identify new therapeutic approaches to resolve this chronic inflammatory process.

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Section: Medical Treatment Optionsmentioning

confidence: 99%

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

Vickery

Ramakrishnan²,

Suh

2019

Curr Allergy Asthma Rep

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“…Medical management is a crucial component in the treatment of CRS, both as a first‐line treatment and as a means for maintaining disease improvement after endoscopic sinus surgery. Medical management of CRS primarily consists of intranasal saline irrigations and intranasal corticosteroids as supported by level‐1 evidence . Using a multifaceted approach that includes both saline irrigations and topical intranasal corticosteroids, the sinonasal inflammation associated with CRS is decreased with a reciprocal improvement in patient outcomes …”

Section: Introductionmentioning

confidence: 99%

Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients

et al. 2019

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Objective Intranasal saline irrigations and intranasal corticosteroids are supported by level‐1 evidence for medical management of chronic rhinosinusitis (CRS). We sought to study adherence with these medications. Methods Prospective study of 174 patients with CRS. Patients reported their usage of intranasal saline irrigation and intranasal corticosteroid over the preceding 3 months, at presentation, and a subsequent follow‐up visit 3 to 12 months later. Adherence was defined as reported medication usage for ≥6 days per week. Results At the time of presentation, 44.3% of patients were using an intranasal corticosteroid spray or irrigation ≥6 days/week, whereas only 24.1% were using saline irrigation ≥6 days per week. At follow‐up, 60.3% of patients were using either an intranasal corticosteroid spray or irrigation ≥6 days per week, whereas 35.6% were using saline irrigation ≥6 days per week. Adherence with intranasal corticosteroids was associated with comorbid asthma (adjusted odds ratio [OR] = 2.68, 95% confidence interval [CI]: 1.10–6.50, P = 0.029), allergy (OR = 2.22, 95% CI: 1.05–4.71, P = 0.037), and change in 22‐item Sinonasal Outcome Test score (OR = 0.98, 95% CI: 0.96–0.99, P = 0.027). Use of intranasal corticosteroid sprays versus irrigations (OR = 2.56, 95% CI: 0.84–7.83, P = 0.099) was suggestive of association with improved adherence. Adherence with intranasal saline irrigation was associated with age (OR = 1.02, 95% CI: 1.01–1.05, P = 0.034). Conclusion Usage and adherence with intranasal steroids and saline may be low in CRS patients even with management in a tertiary level, subspecialty rhinology clinic. Adherence with medications represents a major opportunity for improving patient care and outcomes, specifically by targeting patients with lower disease burden and improving convenience of medications. Level of Evidence 2C Laryngoscope, 130:852–856, 2020

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“…инГКС хорошо изучены по всем вышеперечислен-ным показаниям в РКИ и их метаанализах [8,[41][42][43][44][45][46][47][48][49]. При остром, рецидивирующем и хроническом РС доказана эффективность применения инГКС как в виде монотера-пии, так и в качестве дополнения к антибиотикам [11,13].…”

Section: место интраназальных глюкокортикостероидов (ингкс) в терапииunclassified

The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate

Ушкалова

Zyryanov

Shvarts

2016

Vestn. otorinolaringol.

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Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis

Cited by 138 publications

References 92 publications

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients

The use of intranasal glucocorticosteroids in the treatment of rhinosinusitis: Focus on mometasone furoate

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