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Steroids for acute sinusitis

  • Review
  • Intervention




Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school.


We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2006, issue 4) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1966 to December 2006), EMBASE (1990 to June 2006) and bibliographies of included studies.

Selection criteria

Randomized controlled trials (RCTs) were considered eligible if they compared INCS treatment to placebo treatment of a control group for acute sinusitis; acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work.

Data collection and analysis

Two review authors independently extracted the data, assessed trial quality and resolved discrepancies by consensus.

Main results

Four studies with 1943 participants met the inclusion criteria. The trials were well designed, double-blind, placebo controlled in which the included participants had acute sinusitis. The treatment assigned was INCS versus control treatment for 15 or 21 days. The rates of loss to follow up in the studies were 7%, 11%, 41% and 10%. When the results from the three trials included in the meta-analysis were combined, participants receiving INCS were more likely to have resolution or improvement of symptoms than those receiving placebo (73% versus 66.4%; RR 1.11; 95% CI 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement or complete relief of symptoms: for mometasone furoate (MFNS) 400 mcg versus 200 mcg, (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rate for the two treatment groups and for groups receiving higher doses of INCS.

Authors' conclusions

For acute sinusitis confirmed by radiology or nasal endoscopy, current evidence is limited, but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

Plain language summary

Steroids for acute sinusitis

Acute sinusitis is a common reason for primary care visits; it is one of the 10 most common diagnoses in ambulatory practice. There have been suggestions, based on studies of allergic rhinitis and chronic sinusitis, that intra-nasal corticosteroids (INCS) may relieve symptoms and hasten recovery in acute sinusitis due to their anti-inflammatory properties. A critical systematic review of the literature found four well-conducted, randomized placebo-controlled intervention studies, involving 1943 participants treated for 15 or 21 days. The results suggest that there may be a modest effect with INCS in the resolution or improvement of symptoms. Only minor adverse events were reported. Given the small number of studies included in this review, it is recommended that further randomized controlled trials be conducted.