Topical corticosteroid irrigations in chronic rhinosinusitis

Abstract

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.

Some Features of Clinical Laboratory and Instrumental Research in Chronic Inflammatory Diseases of the Nose and Paranasal Sinuses in Patients with Myocarditis

“…Factors that violate the patency of the natural openings of the paranasal sinuses and the mechanisms of their aeration and cleansing include abnormalities of the development of the nasal concha, curvature of the nasal septum, and deformation of the nasal valve, whose functions have not yet been fully studied [2,3,9,12]. The rendered pathological action creates the conditions for blockade of the ostiomeatal complex, and subsequently the development of the inflammatory process in the paranasal sinuses [4,5,6,7,9,11].…”

“…The rendered pathological action creates the conditions for blockade of the ostiomeatal complex, and subsequently the development of the inflammatory process in the paranasal sinuses [4,5,6,7,9,11]. In conditions of stagnation of the secret and a decrease in the partial pressure of oxygen in the PNS, favorable conditions are created for the development of a bacterial infection [12,13,14,15].…”

“…It has been proven that there is a direct connection between influenza and acute respiratory infections with subsequently developing chronic therapeutic pathology and serious somatic complications [22]. It is considered possible to develop primary heart damage in acute infectious diseases [4,6,12], myocarditis and dilated cardiomyopathy in patients who have had a viral infection [1,9,16]. Of particular relevance is the study of the role of inflammatory diseases of the ENT organs in the occurrence of heart pathology, which very often are the cause of dystrophy of the heart muscle [2], myocarditis and rheumatism [6,8].…”

“…Endoscopy of the nasal cavity is the most reliable method for examining the nasal cavity, the condition of the paranasal sinuses and their natural anastomoses and plays a dominant role in the diagnosis, an objective assessment of the effectiveness of the treatment and the choice of the best option for surgical intervention [4,12].…”

Guidance for contemporary use of biologics in management of chronic rhinosinusitis with nasal polyps: discussion from a National Institutes of Health–sponsored workshop

“…Although current treatment options work well for most patients with nasal polyps, there is a subset of patients that are difficult to treat. The current treatment algorithm includes saline irrigations, topical nasal steroids, and oral steroids or antibiotics as indicated 12 . FESS is reserved as an option for patients who fail medical management.…”