Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations
Corresponding Author
Luke Rudmik MD
Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Correspondence to: Luke Rudmik, MD, University of Calgary, Otolaryngology–Head and Neck Surgery, Foothills Medical Centre Suite 602, South Tower 1403 - 29st NW, Calgary, Alberta T2N 2T9, Canada; e-mail: [email protected]Search for more papers by this authorMonica Hoy MD
Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorRodney J. Schlosser MD
Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
Search for more papers by this authorRichard J. Harvey MD
Rhinology and Sinus Surgery, Applied Medical Research Center St Vincents Hospital, University of New South Wales and Macquarie University, Sydney, Australia
Search for more papers by this authorKevin C. Welch MD
Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, IL
Search for more papers by this authorValerie Lund MD
Professional Unit, Royal National Throat Nose and Ear Hospital, London, UK
Search for more papers by this authorTimothy L. Smith MD, MPH
Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, OR
Search for more papers by this authorCorresponding Author
Luke Rudmik MD
Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Correspondence to: Luke Rudmik, MD, University of Calgary, Otolaryngology–Head and Neck Surgery, Foothills Medical Centre Suite 602, South Tower 1403 - 29st NW, Calgary, Alberta T2N 2T9, Canada; e-mail: [email protected]Search for more papers by this authorMonica Hoy MD
Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Search for more papers by this authorRodney J. Schlosser MD
Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
Search for more papers by this authorRichard J. Harvey MD
Rhinology and Sinus Surgery, Applied Medical Research Center St Vincents Hospital, University of New South Wales and Macquarie University, Sydney, Australia
Search for more papers by this authorKevin C. Welch MD
Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, IL
Search for more papers by this authorValerie Lund MD
Professional Unit, Royal National Throat Nose and Ear Hospital, London, UK
Search for more papers by this authorTimothy L. Smith MD, MPH
Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, OR
Search for more papers by this authorPotential conflict of interest: There were no direct financial costs related to the development of this manuscript. All incoming authors disclosed their conflicts of interest and they are reported in this manuscript. This manuscript was not discussed with industry prior to publication.
Abstract
Background
Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS.
Methods
A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review.
Results
This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations).
Conclusion
Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).
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