Limited evidence for effects of intranasal corticosteroids on symptom relief for recurrent acute rhinosinusitis.

OBJECTIVE: To systematically review the evidence base on the effectiveness of intranasal corticosteroids in adult patients with recurrent acute rhinosinusitis. Data Sources Pubmed, EMBASE, and the Cochrane Library.

REVIEW METHODS: A comprehensive search was performed up to March 20, 2013. Two reviewers independently screened publications on title and abstract. Design of selected studies was assessed on directness of evidence and risk of bias. For included studies, risk differences with 95% confidence intervals were extracted or recalculated.

RESULTS: Of 1850 unique records, 3 trials were included. Risk of bias was high and directness of evidence was low for 2 trials, the third trial had low risk of bias with moderate directness of evidence. They found a statistical significant difference for the median number of days to clinical success (defined as patients' report of symptoms to be cured or much improved) favoring intranasal corticosteroids (6 days) over placebo (9 days), while the difference in proportion of patients reporting clinical success after 21 days of treatment was 20% favoring intranasal corticosteroids over placebo.

CONCLUSION AND RECOMMENDATION: The evidence for the benefit of intranasal corticosteroids on symptom relief in adult patients with recurrent acute rhinosinusitis is rather limited (ie, 3 trials are available; the best evidence is derived from 1 low risk of bias trial providing moderate directness of evidence that intranasal corticosteroids may speed up relief of symptoms in patients with recurrent acute rhinosinusitis). A large methodologically rigorous randomized trial in antibiotic-naïve patients is needed to provide a more definite recommendation.