388 Topical corticosteroids effective for nasal polyps

May 31, 2013

PEARLS 388, April 2013, written by Brian R McAvoy.

Clinical Question
How effective are topical corticosteroids in patients with chronic rhinosinusitis with nasal polyps?

Bottom Line
Topical nasal corticosteroids should be considered part of medical treatment for chronic rhinosinusitis with nasal polyps. Topical nasal corticosteroids had beneficial effects on symptoms, polyp size and polyp recurrence, with little evidence of significant adverse effects. When a low dose was compared to a high dose of topical corticosteroid, no difference was evident for symptom control, polyp size and polyp recurrence. The effect on polyp size may be greater when the topical corticosteroid is administered after sinus surgery.

Caveat
Although these data consistently favoured topical corticosteroids, there was also significant heterogeneity seen and variability in the effect size. There was not enough information regarding the extent of previous surgery to consider the role of simple polypectomy versus more comprehensive sinus surgery. Symptoms were scored differently across included studies.

Nasal polyps develop as a result of chronic inflammation of the mucous lining of the nose and sinuses and they can cause nasal obstruction, poor sinus drainage, and loss of smell/taste, a runny nose or nasal congestion. Topical corticosteroids have been the most widely used treatment, with each clinician using different regimens, at different doses, in different settings and with or without sinus surgery 

Cochrane Systematic Review Kalish L et al. Topical steroids for nasal polyps. Cochrane Reviews, 2012, Issue 12. Art. No.: CD006549.DOI: 10.1002/14651858. CD006549.pub2. This review contains 40 studies involving 3,624 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.