Comparing topical steroids for rhinosinusitis & nasal polyps
Published: August 12, 2022
People who have chronic inflammation of their sinuses can experience nasal blockage, thick nasal drainage, a decrease in or loss of sense of smell, and/or facial pain or pressure sensations. This condition is called chronic rhinosinusitis. These symptoms can have a large negative impact on a person’s quality of life. Some people with chronic rhinosinusitis also form nasal polyps, which are growths that form from the lining of the nose and sinuses. Nasal polyps are not cancerous or painful. The inflammation and polyp formation in the nose and sinuses are due to abnormalities in a person’s immune system. Previous studies suggest that steroid medicines can help calm the inflammation and shrink the polyps. Steroid medicines can be given as pills or shots, which means the medicine travels throughout the body’s circulation. Long term use of steroid pills or shots can have significant side effects. Steroid medicines that are applied more directly to the nose and sinus (i.e. topical steroids) are thought to be safer to use over the longer term because they are not absorbed very much into the blood. These topical medicines have been used for several decades to treat chronic rhinosinusitis and nasal polyps. However, there are many different types of topical steroids and it is not clear which of them are best for people with sinus inflammation and nasal polyps.
This study by Bognanni et al, published in the The Journal of Allergy and Clinical Immunology (JACI), identifies previously performed research studies that used topical steroids for sinus inflammation with nasal polyps. Finding all relevant studies is a research method called systematic review. Once the studies were identified, the team used several accepted research and statistical methods to merge the information together so that conclusions could be drawn about the different types of topical steroids. Merging the information together is called a meta-analysis and a meta-analysis that compares multiple treatments for one condition at the same time is called a network meta-analysis. It is very important to know that each individual study that was included in the meta-analysis underwent a thorough evaluation by the team. This included assessing the risks of bias in an individual study which could threaten the validity of the research findings. The overall process that the authors used for assessing each study and how the studies mesh is called Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
The study team found 61 studies of topical steroids that used a randomized controlled design to test how well the medicine works in people with chronic rhinosinusitis and nasal polyps. There were 8 different types of topical steroids that were grouped together in the analysis. A total of 7,176 people participated in the studies that were used in the network meta-analysis. The authors found that sinusitis-related quality of life might improve with topical steroid rinses and with topical steroids using an exhalation delivery system when comparing the results with people who did not use topical steroids (i.e., people in the placebo group). The size of the improvement in sinusitis-related quality of life with topical steroids was small. The certainty about the results for sinusitis-related quality of life was rated as low by the team. The authors found that nasal obstruction symptoms are likely improved with topical steroids using stents or dressings applied directly to the nose and sinuses, sprays, and exhalation delivery systems when compared to people in the placebo group. The size of improvement in nasal obstruction was small-to-medium. The certainty about the results for nasal obstruction was moderate-to-high. The authors found no important differences in side effects among the different topical steroids.
The authors found that many different types of topical steroids help people with chronic rhinosinusitis and nasal polyposis. They found important differences between the types of topical steroids that can help guide a discussion between patients and their health care team.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
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