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 The ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of corticosteroids given topically, by a spray into the nose, for CRSwNP. Forty Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). A trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). (RCTs) with 3264 adults were included. 36 RCTs compared topical corticosteroids with An intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. and 4 with no Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes.. The reviewers were primarily interested in the effect of Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. 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 Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. and control groups; side effects were minor and infrequent
How good is the evidence?
- The Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. were judged to be at low (21 RCTs), medium (13 RCTs) and high (6 RCTs) A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of Any factor, recognised or not, that distorts the findings of a study. For example, reporting bias is a type of bias that occurs when researchers, or others (e.g. drug companies) choose not report or publish the results of a study, or do not provide full information about a study.
- 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 Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 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