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Literature Review: A Roundup of Important Recent Studies

Oral Steroids in Chronic Rhinosinusitis

What is the evidence to support the use of oral steroids in the management of chronic rhinosinusitis with or without polyps?

Background: Oral steroids are used frequently by otolaryngologists to assist in the management of chronic rhinosinusitis with polyps (CRSwP) or without polyps (CRSsP). Data to support this use, however, is unclear.

Study design: Systematic evidence-based literature review with iterative author assessment.

Setting: Academic medical centers.

Synopsis: The authors divided their review into assessments of oral steroid use in CRSwP, CRSsP and allergic fungal sinusitis (AFS), as well as peri-operative use of steroids in each category. Evidence was found to be strongest for steroid use in short term management of CRSwP with an overall assessment of “strong recommendation,” while in AFS they were “recommended.” Similarly, oral steroids were “strongly recommended” in the perioperative period for CRSwP and AFS. With insufficient strong evidence, oral steroids were thought to be “optional” in short-term management of CRSsP, while “no recommendation” was made for their use in the peri-operative period for CRSsNP.

Bottom line: Evidence supporting the use for oral steroids in the management of CRS is strongest in the presence of polyps and AFS, and their use is strongly recommended. Evidence is not as strong for their use in CRSsP, however, and their use remains optional. They are also recommended in the perioperative management of CRSwP and AFS.

Citation: Poetker DM, Jakubowski LA, Lal D, Hwang PH, Wright ED, Smith TL. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:104-120.

—Reviewed by Brent Senior, MD

Macrolide Therapy for Chronic Rhinosinusitis

What is the evidence to support the use of long-term macrolide therapy for management of chronic rhinosinusitis (CRS)?

Background: CRS, a disorder of chronic inflammation, frequently responds well to anti-inflammatory medications such as steroids. Macrolides are a unique class of antimicrobial that exhibit anti-inflammatory activity and have been advocated for treatment of CRS.

Study design: Systematic literature review of EMBASE and PubMed databases.