The following is a summary of the “Review of evidence supporting the use of nasal corticosteroid irrigation for chronic rhinosinusitis,” published in the January 2023 issue of Allergy and Clinical Immunology by Bernstein et al.
This study aims to critically appraise the therapeutic implications of the present evidence gaps and review published studies on the effectiveness and safety of CSI in CRS. Chronic rhinosinusitis (CRS) with nasal polyps is often treated with corticosteroid irrigation (CSI), even though this practice is not authorized by the US Food and Drug Administration (FDA). Therefore, chronic rhinosinusitis/nasal polyps and corticosteroid irrigation/steroid nasal lavage/sinus rinse were searched for together.
Researchers looked at 19 studies (9 controlled, 10 uncontrolled trials), 7 reviews, and 1 meta-analysis that reported on the safety and effectiveness of CSI for people with CRS.
Varying solution volumes (60 mL to 125 mL per nostril), corticosteroid agents (budesonide, betamethasone, mometasone, or fluticasone), corticosteroid doses, preparation techniques (by compounding pharmacy or by the patient), and administration methods made it hard to compare studies (frequency, time of day, body positioning).
Studies were often small, showed modest benefits, and rarely investigated the safety, making it difficult to understand which characteristics might greatly influence clinical effects. Small sample numbers may explain why no studies examining CSI have found statistically significant differences in a type-I error-controlled primary endpoint compared to any comparator. Building stronger clinical studies could assist in establishing CSI’s efficacy. Medical providers should give serious consideration to using FDA-approved medications for the treatment of CRS rather than CSIs until more evidence supporting CSI use is available.
Source: sciencedirect.com/science/article/pii/S1081120622017215