Sinusitis

Review Identifies Optimal Treatment for Adult Chronic Sinusitis

Topical intranasal corticosteroids plus saline irrigation are the optimal first-line treatment for adults with chronic sinusitis, according to a systematic review.

Note: The evidence and recommendation were given the highest possible grade, A-I.
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“[Chronic sinusitis] accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures. Appropriate use of medical therapies for chronic sinusitis is necessary to optimize patient quality of life and daily functioning and minimize the risk of acute inflammatory exacerbations.”

In order to provide recommendations based on the highest-quality evidence associated with the treatment of adult chronic sinusitis, researchers conducted a systematic review of 29 studies: 12 meta-analyses, 13 systematic reviews, and 4 randomized clinical trials.

Overall, researchers found that saline irrigation (standardized mean difference [SMD], 1.42 [95% CI, 1.01 to 1.84]; a positive SMD indicates improvement) and topical corticosteroid therapy (SMD, −0.46 [95% CI, −0.65 to −0.27]; a negative SMD indicates improvement) significantly improved symptom scores.

Other recommendations included:

  • Leukotriene antagonists for maintenance therapy of sinusitis with polyps (A-II).
  • Systemic corticosteroids as intermittent or rescue therapy for patients with nasal polyps (A-1)
  • Short-term antibiotics and long-term macrolides in patients without polyps (A-II). 

“Evidence supports daily high-volume saline irrigation with topical corticosteroid therapy as a first-line therapy for chronic sinusitis,” they concluded.

“A short course of systemic corticosteroids (1-3 weeks), short course of doxycycline (3 weeks), or a leukotriene antagonist may be considered in patients with nasal polyps. A prolonged course (3 months) of macrolide antibiotic may be considered for patients without polyps.”

—Michael Potts

Reference:

Rudmik L, Soler ZM. Medical therapies for adult chronic sinusistis. JAMA. 2015;314(9):926-939.