Antibiotics, Steroids, and Combination Therapy in Chronic Rhinosinusitis without Nasal Polyps in Adults

Abstract

Despite a lack of robust data regarding their efficacy, oral antibiotics and steroids remain two of the most common treatments for chronic rhinosinusitis without nasal polyps (CRSsNP). We sought to objectively compare the efficacy of antibiotics and steroids, independently and in combination, for the initial treatment of CRSsNP. To that end, we conducted a retrospective chart review of 100 patients—51 men and 49 women, age 20 to 85 years (mean: 50)—who were treated for CRSsNP from January 2010 through January 2015. Of this group, 17 patients were treated with an antibiotic only, 28 with a steroid only, and 55 with both agents. All patients underwent computed tomography (CT) before and after treatment, and we compared the three groups’ pre- and post-treatment Lund-Mackay CT scores, symptom scores, and rates of surgery. The average time between the pre- and post-treatment visits was 4.4 weeks. The mean Lund-Mackay CT score for the entire study population was significantly lower after treatment than at baseline (6.3 vs. 9.1; p < 0.001); however, there were no significant differences among the three groups in either pre- or post-treatment scores. Symptom scores were significantly better in the combination therapy group than in the two monotherapy groups (p < 0.001). In all, 40 of the 100 patients underwent surgery; the difference in surgery rates among the three groups was not statistically significant (p = 0.884). Surgery was performed on 9 of the 52 (17.3%) patients who either were followed for at least 1 year or who had had surgery within the first year postoperatively; again, there were no significant differences among the three groups (p = 0.578). We conclude that although the Lund-Mackay CT scores decreased significantly in the antibiotic, steroid, and combination therapy groups, no one regimen was superior to any other for treating CRSsNP in our study.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Liu 2018 1090 described 100 patients diagnosed with CRSsNP, treated either with oral antibiotics, oral corticosteroids or both. The corticosteroid agents used were either methylprednisolone for 6 days or prednisone for 20 days.…”

“…Liu et al evaluated 5 years of patient data to compare patients with CRSsNP who were treated with 1) non‐macrolide antibiotics, 2) steroids, or 3) a combination of the 2 1090 . Patients were treated with a variety of antibiotics for a range of 10 to 21 days (median 21 days in the antibiotic only group and 14 days in the combination group) and/or a variable steroid regimen.…”

Histopathologic Influences of Comorbid Smoking Status in Chronic Rhinosinusitis

“…Steroids have been well established as an anti-inflammation treatment regimen for CRS. 19–21 The established cutoff value for sinus tissue eosinophilia of “5/HPF” is a potential limitation of this study as studies have utilized different approaches to define eosinophilia in sinus tissue. 8,22,23 Specific histopathologic characteristics of CRS disease, namely, the presence of eosinophil aggregates, has been associated with increased steroid requirements for disease control.…”

International consensus statement on allergy and rhinology: Olfaction

“…Additionally, many of the included studies look broadly at patients with CRS, but the majority of these CRS cohorts include patients with AR. While these studies demonstrate improvement in subjective measures of olfaction following turbinate reduction, the data on objective measures are mixed 1631,1633 . Although turbinate reduction is generally performed in patients with AR who have nasal congestion refractory to medical therapy, no recommendation can be made for patients with AR‐related OD because of the paucity of available evidence.…”

“…Although there are various surgical therapies for management of allergic nasal symptoms refractory to medical management, the available postsurgical olfactory outcomes data exist primarily for inferior turbinate surgery. [1631][1632][1633][1634][1635] In patients with CRS, OD is associated with the presence of polyps, asthma, DM, and older age. 1636 ESS is usually considered after appropriate medical therapy has failed to control bothersome symptoms.…”