Topical corticosteroid irrigations in chronic rhinosinusitis

Jessica W. Grayson*, Richard J. Harvey

*Corresponding author for this work

Research output: Contribution to journalReview article

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)S9-S15
Number of pages7
JournalInternational Forum of Allergy and Rhinology
Volume9
Issue numberS1
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • chronic rhinosinusitis
  • corticosteroid use
  • endoscopic sinus surgery
  • FESS
  • irrigations
  • medical therapy of chronic rhinosinusitis
  • paranasal sinus diseases

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