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Chronic sinusitis: a survey of medical therapies

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A systematic review of therapies for chronic sinusitis in adults

Chronic sinusitis is a common inflammatory disease characterized by persistent symptomatic inflammation of the nasal cavities lasting longer than 3 months. It has been found that between 1% and 2% of all medical visits involve chronic sinusitis, accompanied by the resulting economic burden on the healthcare system. The appropriate use of medical therapies for chronic sinusitis is essential to improve the patient's quality of life and daily routine, as well as to reduce the risk of exacerbations from acute inflammation.

Researchers Luke Rudmik and Zachary M. Soler conducted a survey limited to randomized clinical trials, systematic reviews, and meta-analyses from the Ovid MEDLINE (1947–January 30, 2015), EMBASE, and Cochrane databases. The data collected were divided into maintenance, intermittent, or rescue therapies and reported according to the presence or absence of nasal polyposis. The objective was to summarize qualitatively valid evidence on medical therapies for chronic sinusitis in adults and create a data-driven approach to optimize patient care.

THE RESULTS

Twenty-nine studies met the inclusion criteria: 12 meta-analyses (>60 RCTs), 13 systematic reviews, and 4 RCTs that were not included in any meta-analysis.

  • Irrigation with saline solutionirrigation with saline solution improved symptom scores compared to no treatment.
  • Topical corticosteroid therapies improved overall symptom scores in polyposis and reduced post-surgical recurrences.
  • Systemic corticosteroids and oral doxycycline (both for 3 weeks) reduced the size of nasal polyps compared with placebo in the three months after treatment (P < .001).
  • Leukotriene antagonists improved nasal symptoms compared with placebo in patients with nasal polyposis (P < .01).
  • The macrolide antibiotic for 3 months was associated with improved quality of life at only one time point (24 weeks after therapy) compared to placebo for patients without polyps.

CONCLUSIONS

The data indicate thathigh-volume daily irrigation, together with corticosteroid therapy, should be considered the first-line treatment for chronic sinusitis. In patients with nasal polyposis, short-term systemic corticosteroid therapy (1-3 weeks), short-term doxycycline therapy (3 weeks), or a leukotriene antagonist may be considered. For patients without polyposis, prolonged therapy (3 months) with macrolide antibiotics may be considered.

 

Translated into Italian by the author

Source: Luke Rudmik, MD, MSc; Zachary M. Soler, MD, MSc, JAMA. 2015;314(9):926-939. doi:10.1001/jama.2015.7544

 

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