Potential 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.
Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations
Article first published online: 8 OCT 2012
© 2013 ARS-AAOA, LLC
International Forum of Allergy & Rhinology
Volume 3, Issue 4, pages 281–298, April 2013
How to Cite
How to Cite this Article: Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Forum Allergy Rhinol, 2013; 3:281–298., , , et al.
- Issue published online: 8 APR 2013
- Article first published online: 8 OCT 2012
- Manuscript Accepted: 21 JUL 2012
- Manuscript Revised: 27 JUN 2012
- Manuscript Received: 5 APR 2012
- chronic rhinosinusitis;
- evidence-based medicine;
- medical therapy of chronic rhinosinusitis;
- topical therapy for chronic rhinosinusitis
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.
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.
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).
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).