Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, short follow-up time) and inconsistency (heterogeneity in patients, interventions and outcomes).
A Cochrane review [Abstract] 2 included 18 RCTs with a total of 2738 patients. The patients were with nasal polyps in 14 studies and without in 4 studies. Only one study was conducted in children.The trials studied intranasal corticosteroids vs. placebo or no intervention.Only one study (n=20 without polyps) measured the primary outcome, disease-specific HRQL using the Rhinosinusitis Outcome Measures-31 (RSOM-31). There was no significant difference (numerical data not available).The second primary outcome, disease severity , was measured using the Chronic Sinusitis Survey in a study (n=134, without polyps), which found no difference (MD 2.84, 95% CI -5.02 to 10.70; scale 0 to 100). Another study (chronic rhinosinusitis with nasal polyps) reported an increased chance of improvement in the intranasal corticosteroids group (RR 2.78, 95% CI 1.76 to 4.40; n=109). Six studies provided data on at least 2 of the symptoms used in the EPOS 2012 criteria to define chronic rhinosinusitis (nasal blockage, rhinorrhoea, loss of sense of smell and facial pain/pressure). When all 4 symptoms in the EPOS criteria were available on a scale of 0 to 3 (higher = more severe symptoms), the average MD in change from baseline was -0.26 (95% CI -0.37 to -0.15; 2 studies, n=243). Although there were more studies for only nasal blockage and rhinorrhoea (MD -0.31, 95% CI -0.38 to -0.24; 6 studies, n=1702), the MD was almost identical to when loss of sense of smell was also considered (4 studies; n=1345).When considering the results for the individual symptoms, benefit was shown in the intranasal corticosteroids group. The effect size was larger for nasal blockage (MD -0.40, 95% CI -0.52 to -0.29; 6 studies, n=1702) than for rhinorrhoea (MD -0.25, 95% CI -0.33 to -0.17; 6 studies, n=1702) or loss of sense of smell (MD -0.19, 95% CI -0.28 to -0.11; 4 studies, n=1345). There was heterogeneity in the analysis for facial pain/pressure (MD -0.27, 95% CI -0.56 to 0.02; 2 studies, n=243). There was an increased risk of epistaxis with intranasal corticosteroids (RR 2.74, 95% CI 1.88 to 4.00; 13 studies, n=2508).It is unclear whether there is a difference in the risk of local irritation (RR 0.94, 95% CI 0.53 to 1.64; 11 studies, n=2124).
Another Cochrane review [Abstract] 3 included 9 RCTs with a total of 911 patients. None of the studies evaluated the first primary outcome measure, disease-specific HRQL.
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