Key message: Topical steroids are a beneficial treatment for chronic rhinosinusitis with nasal polyps and the adverse effects are minor, with benefits outweighing the risks.
Chronic rhinosinusitis (CRS) is prolonged inflammation of the mucosa of the nose and sinuses, giving rise to a blocked or runny nose and sometimes to facial pain and loss of smell, lasting more than twelve weeks. Some people with CRS also develop nasal polyps (this combination goes under the snappy acronym CRSwNP). The main aim of treatment is to relieve symptoms by reducing or eliminating polyps and the usual first-line approach in medical management is to give corticosteroids. A new review from the Cochrane Ear, Nose and Throat Disorders Group has evaluated the effectiveness of corticosteroids given topically, by a spray into the nose, for CRSwNP. Forty randomized controlled trials (RCTs) with 3264 adults were included. 36 RCTs compared topical corticosteroids with placebo and 4 with no treatment. The reviewers were primarily interested in the effect of treatment on symptoms, polyp size and polyp recurrence.
What did they find?
- Topical corticosteroids improved overall symptom scores and a higher proportion of people had a reduction in symptoms
- Topical corticosteroids decreased polyp size and a higher proportion of people had a reduced polyp size
- Topical corticosteroids were better at preventing polyp recurrence after surgery
- Subgroups analysis suggested that topical corticosteroids had a greater benefit in terms of reduction in polyp size when given any time after sinus surgery compared with people who had never had surgery
- There was no difference in side effects between treatment and control groups; side effects were minor and infrequent
How good is the evidence?
- The trials were judged to be at low (21 RCTs), medium (13 RCTs) and high (6 RCTs) risk of bias
- Results were comparable for high quality and medium quality studies for symptoms, polyp size and polyp recurrence
This review strengthens the evidence in favour of using topical steroids for this condition. It joins an earlier Cochrane review on the use of topical steroids for CRS without polyps, which showed improvements in symptom control, with direct delivery into the sinus being most effective.
Kalish L, Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. Topical steroids for nasal polyps. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006549.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006549.pub2/abstract
Snidvongs K, Kalish L, Sacks R, Craig JC, Harvey RJ. Topical steroid for chronic rhinosinusitis without polyps. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD009274. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009274/abstract