Journal article
Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta‐analysis
International forum of allergy & rhinology, v 14(9), pp 1477-1487
Sep 2024
PMID: 38787291
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re‐examination of the current literature. Methods Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo‐controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio). Results Ten trials (N = 751) were included for meta‐analysis, with a mean age of 47.5 years (range: 18–80 years; 95% confidence interval [CI]: 43.9–51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3–0.6; p < 0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1–0.7; p = 0.01), but not with topical spray (Δ0.04; 95% CI: −0.9 to 1.0; p = 0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9–6.0; p < 0.0001; OR: 12.4; 95% CI: 1.8–83.8; p < 0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9–4.0; p = 0.12). Conclusions Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.
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Details
- Title
- Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta‐analysis
- Creators
- Akash M. Bhat - Medical University of South CarolinaLuke D. Heiland - Medical University of South CarolinaShaun A. Nguyen - Medical University of South CarolinaVinay K. Rathi - Medical University of South CarolinaRodney J. Schlosser - Medical University of South CarolinaZachary M. Soler - Medical University of South Carolina
- Publication Details
- International forum of allergy & rhinology, v 14(9), pp 1477-1487
- Number of pages
- 11
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001230412700001
- Scopus ID
- 2-s2.0-85193916312
- Other Identifier
- 991022202120804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Otorhinolaryngology