Limited Evidence for Effects of Intranasal Corticosteroids on Symptom Relief for Recurrent Acute Rhinosinusitis

Loon, Juliette W. L. van; Harn, Rochustina P. van; Venekamp, Roderick P; Kaper, Nina M.; Sachs, A. P. E.; Heijden, Geert J. M. G. van der

doi:10.1177/0194599813503791

Cited by 13 publications

(7 citation statements)

References 10 publications

(50 reference statements)

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“…All studies reported improvement in symptoms in the treatment groups. In addition, a recent systematic review by van Loon et al 199 summarized the impact of INCS use on symptom relief in patients with RARS. Dolor et al 192 demonstrated significant improvement in median days to clinical success (6 in treatment group vs 9 in placebo group; p = 0.01) with intranasal fluticasone.…”

Section: Vid1 Rars Management: Incsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

548

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Vid1 Rars Management: Incsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

548

888

View full text Add to dashboard Cite

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“…3 Similarly, the evidence for the use of intranasal corticosteroids has also been reported to be limited. 4 The role of surgical therapy is even less well studied, although a recent publication by Poetker et al 5 showed that surgery may result in a reduction in both medication use and symptom burden in patients with RARS.…”

Section: Discussionmentioning

confidence: 99%

“…Recent systematic reviews of medical therapy for RARS have shown no evidence for the use of oral antibiotics and limited evidence for intranasal corticosteroids. 3,4 Studies of surgical treatment have showed significant improvement in the quality of life of patients undergoing surgery for RARS. 5,6 However, no studies so far have compared the outcomes between medical and surgical treatment strategies.…”

mentioning

confidence: 99%

Medical therapy vs surgery for recurrent acute rhinosinusitis

Costa

Psaltis

Nayak

et al. 2015

Int Forum Allergy Rhinol

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RARS patients can benefit from both medical and surgical treatment strategies, but surgical treatment results in greater symptomatic improvement compared to medical treatment. Patients cross over from medical to surgical treatment when SNOT-22 scores escalate by a mean of 15 points. Haller cell, concha bullosa, and accessory ostium are associated with RARS but are equally common in medical, surgical, and crossover cohorts.

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“…Evidence supports that use of daily INS therapy during and between episodes of ABRS may reduce frequency of ABRS episodes and improve overall QoL. 25,26 Given the low risk for adverse events and potential clinical benefit, a trial of INS therapy is an appropriate intervention prior to considering surgery. 24 Number of ABRS episodes per year 1.…”

Section: Yesmentioning

confidence: 99%

“…Topical nasal corticosteroids appear to lead to earlier symptomatic improvement for patients with RARS, although a definitive benefit has not been demonstrated. 25 Surgical outcomes for RARS have been explored. Patients with RARS who undergo ESS report improved symptoms and QoL and decreased missed work days, with mixed results on decreases in antibiotic and sinus medication utilization postoperatively.…”

Section: Challenges With Rars Management and Researchmentioning

confidence: 99%

Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis

et al. 2018

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Objectives/Hypothesis Endoscopic sinus surgery (ESS) is frequently performed for recurrent acute rhinosinusitis (RARS). Appropriate indications for surgery among patients with RARS have not yet been rigorously determined. The objective of this study was to define appropriateness criteria for ESS in the management of adult RARS. Study Design Application of RAND‐UCLA appropriateness methodology. Methods A panel of nine multidisciplinary experts in RARS was formed to evaluate RARS scenarios generated from current evidence. The panel completed two rounds of a modified Delphi‐ranking process and a teleconference. Results A total of 32 clinical scenarios were ranked in each round. For adult patients with RARS, ESS can appropriately be offered as a treatment option when patients experience ≥ four annual episodes, and there is confirmation of at least one episode via computed tomography or nasal endoscopy, and the patient and clinician jointly participate in shared decision making, and the patient has either failed a trial of topical nasal steroids or experienced RARS‐related productivity loss. Conclusions This study has defined appropriateness criteria for ESS as a management option for adult patients with RARS. These criteria are intended to represent a minimum threshold for which ESS should be considered in the treatment of RARS and do not suggest that all patients who meet these criteria should undergo surgery. These criteria may serve as a baseline set of indications for ESS in patients with RARS. Level of Evidence NA Laryngoscope, 129:37–44, 2019

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Limited Evidence for Effects of Intranasal Corticosteroids on Symptom Relief for Recurrent Acute Rhinosinusitis

Cited by 13 publications

References 10 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Medical therapy vs surgery for recurrent acute rhinosinusitis

Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis

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