Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

Kosugi, Eduardo Macoto; Moussalem, Guilherme Figner; Simões, Juliana Caminha; Souza, Rafael de Paula e Silva Felici de; Chen, Vitor Guo; Neto, Paulo Saraceni; Neto, José Arruda Mendes

doi:10.1016/j.bjorl.2015.03.014

Cited by 34 publications

(34 citation statements)

References 27 publications

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“…Outcomes analysed were disease-specific QOL questionnaire assessments 1,2,6-10 and endoscopy score. [6][7][8][9][10] Additionally, adverse effects related to steroid irrigation were analysed as hypothalamus-pituitary-adrenal (HPA) axis suppression 1,4,5,8,11,12 and intraocular pressure (IOP) increase. 4,5,8,13 Comparisons between pre-and post-treatment values or between post-treatment vs control (saline irrigation) during a follow-up period (after 3 months after starting the steroid irrigation) were analysed.…”

Section: Data Extractionmentioning

confidence: 99%

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Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis

Yoon

Lee

Kim

et al. 2017

Clinical Otolaryngology

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Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regard to endoscopic score and CRS-related QOL improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

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Section: Data Extractionmentioning

confidence: 99%

“…Four studies 1,2,9,10 assessed the efficacy of steroid irrigation on QOL. Steroid irrigation that was applied for more than 3 months significantly improved the QOL (MD = 21.92; I 2 = 34.69%; [95% CI]:…”

Section: Quality Of Life After Steroid Nasal Irrigationmentioning

confidence: 99%

Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis

Yoon

Lee

Kim

et al. 2017

Clinical Otolaryngology

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“…Although dose may not play a significant role, the ability of the medication to reach the sinuses via large‐volume lavage is essential. Three studies used large‐volume (240 mL) corticosteroid irrigations with 0.5‐1 mg of budesonide vs saline and 2 of the 3 studies reported significant improvement in symptoms and clinical scoring . The study without improvement used 1 mg/d budesonide for 1 month.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple corticosteroids were used in the aforementioned studies, including mometasone, fluticasone, betamethasone, and budesonide . Fluticasone and betamethasone were not studied for effectiveness of treatment, but were instead evaluated for safety.…”

Section: Discussionmentioning

confidence: 99%

Topical corticosteroid irrigations in chronic rhinosinusitis

Grayson

Harvey

2019

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis (CRS) has previously been thought to occur secondary to infectious or obstructive etiologies. However, in recent years, primary CRS has been more discretely defined as diffuse airway inflammation, similar to asthma. Adequate medical and surgical therapy are needed to control the inflammation. Our purpose in this study was to evaluate the efficacy and safety of topical corticosteroid treatment. Methods A focused literature review was conducted and we identified 11 original articles from the years 2013‐2018 evaluating safety or efficacy of topical corticosteroid irrigations. Results Eleven articles were identified. One study found significant benefit between corticosteroid irrigations versus corticosteroid sprays. Two studies found significant benefit between corticosteroid irrigations compared to saline irrigations while two did not. One study found significant improvement in certain patient populations when using corticosteroid irrigations compared to no irrigation. Five studies found no significant increase in risk of adverse side effects with the use of topical corticosteroids. Conclusion Many factors are associated with efficacious and adequate treatment of primary CRS. The pathology must be correctly diagnosed and be inflammatory in nature. The treatment paradigm should include wide and complete endoscopic sinus surgery for the adequate delivery of topical therapy. Topical therapy should be delivered in large‐volume, low‐pressure devices with adequate dosing. Although there is some systemic absorption, multiple studies have demonstrated that long‐term, daily use of topical corticosteroids does not increase intraocular pressure, suppress the hypothalamic‐pituitary‐adrenal axis, or increase the risk of subcapsular cataracts. Therefore, topical corticosteroid irrigations should be considered a part of first‐line medical treatment in postsurgical CRS patients.

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“…Despite this, the clinical data for the effectiveness of corticosteroids delivered by nasal irrigation as superior to nasal sprays has been limited by study design, heterogeneity of surgical practice, short follow‐up, and underpowered analyses . However, there is substantial evidence of effect …”

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confidence: 99%

Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double‐blinded placebo‐controlled trial for chronic rhinosinusitis after sinus surgery

Harvey

Snidvongs

Kalish

et al. 2018

Int Forum Allergy Rhinol

115

101

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Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

Abstract: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.

Cited by 34 publications

References 27 publications

Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis

Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis

Topical corticosteroid irrigations in chronic rhinosinusitis

Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double‐blinded placebo‐controlled trial for chronic rhinosinusitis after sinus surgery

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