Intranasal corticosteroids may help symptoms in acute sinusitis

Intranasal corticosteroids may help relieve symptoms in acute sinusitis, according to a new study.

Researchers performed a systematic review and meta-analysis to determine the effects of intranasal corticosteroids on acute sinusitis symptoms. MEDLINE, EMBASE, the Cochrane Center Register of Controlled Trials and the Centre for Reviews and Dissemination were searched up to February 2011 for studies that compared intranasal corticosteroids and placebo in children or adults with clinical signs and symptoms of acute sinusitis or rhinosinusitis in ambulatory care. Studies that examined chronic or allergic sinusitis were excluded. The study results appeared in the May/June Annals of Family Medicine.

A total of six studies with 2,495 patients were included. In five of these studies, patients were taking antibiotics in addition to intranasal corticosteroids. The authors found that intranasal corticosteroids led to a small but significant increase in resolution or improvement of symptoms, usually facial pain and congestion, at days 14 to 21 (risk difference, 0.08; 95% CI, 0.03 to 0.13). Subgroup analysis by time found that the beneficial effect was significant at 21 days but not at 14 to 15 days, and a meta-regression analysis of trials that used different doses of mometasone furoate found a significant dose-response relationship (P=0.02).

The authors noted that their analysis was limited by the frequent co-administration of corticosteroids and antibiotics. In addition, the included studies used different types, doses and durations of therapy and were underpowered to detect rare adverse effects, among other limitations. However, the authors concluded that intranasal corticosteroids offer a small benefit in improving acute sinusitis symptoms that might be greater with longer use (21 days) and at higher doses.

“Future trials in antibiotic-naïve patients that clarify the time-course of clinical benefit and the impact on work and quality of life will be important to guide management of this common condition,” they wrote.

The author of an accompanying editorial, however, felt that the study did not show enough of a difference in symptom relief with intranasal steroids and that the time frame for improvement in symptoms was too long. “Most patients want to get better in a few days, not 3 weeks,” he wrote.