Medical Therapies for Adult Chronic Sinusitis: A Systematic Review
Abstract
Importance Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months. It accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures. Appropriate use of medical therapies for chronic sinusitis is necessary to optimize patient quality of life (QOL) and daily functioning and minimize the risk of acute inflammatory exacerbations. Objective To summarize the highest-quality evidence on medical therapies for adult chronic sinusitis and provide an evidence-based approach to assist in optimizing patient care. Evidence review A systematic review searched Ovid MEDLINE (1947-January 30, 2015), EMBASE, and Cochrane Databases. The search was limited to randomized clinical trials (RCTs), systematic reviews, and meta-analyses. Evidence was categorized into maintenance and intermittent or rescue therapies and reported based on the presence or absence of nasal polyps. Findings Twenty-nine studies met inclusion criteria: 12 meta-analyses (>60 RCTs), 13 systematic reviews, and 4 RCTs that were not included in any of the meta-analyses. Saline irrigation improved symptom scores compared with no treatment (standardized mean difference [SMD], 1.42 [95% CI, 1.01 to 1.84]; a positive SMD indicates improvement). Topical corticosteroid therapy improved overall symptom scores (SMD, -0.46 [95% CI, -0.65 to -0.27]; a negative SMD indicates improvement), improved po…
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There is no scientific evidence of efficacy of menthol, mucolytics, furosemide, and proton pump inhibitors for NO.
“There is no scientific evidence of the efficacy of other treatment options, such as menthol, mucolytics, furosemide, and proton pump inhibitors, with the result that they are not recommended [162].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [162]
Cites
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Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., & Koffel, J. (2019) · doi:10.31219/osf.io/sfc38 · Cited by 3,696 · see citing works
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Position Paper on Nasal Obstruction: Evaluation and Treatment
SEAIC Rhinoconjunctivitis Committee & SEORL Rhinology, A., Valero, A., Navarro, A., del Cuvillo, A., Alobid, I., Benito, Jr., Colás, C., de los Santos, G., Fernández Liesa, R., García-Lliberós, A., et al. (2018) · Journal of Investigational Allergology and Clinical Immunology · doi:10.18176/jiaci.0232 · Cited by 76 · see citing works
- Authors
- Rudmik, L., & Soler, Z. M.
- Affiliations
- University of Calgary (CA)
- Medical University of South Carolina (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-09-01
- Volume
- 314
- Issue
- 9
- Pages
- 926
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1540339258
- Cited by
- 166
- References
- 4
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 16 · 2020: 15 · 2019: 18 · 2018: 12 · 2017: 19 · 2016: 21 · 2015: 3
- FWCI
- 16.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- chronic rhinosinusitis, medical therapy, nasal polyps, saline water irrigation, topical corticosteroids, systemic corticosteroids, doxycycline, leukotriene antagonists, macrolide antibiotics, maintenance therapy, quality of life, adults, evidence-based treatment recommendations, health care expenditure, symptom scores, polyp size
- MeSH terms
- Adrenal Cortex Hormones, Adult, Anti-Bacterial Agents, Antifungal Agents, Chronic Disease, Doxycycline, Histamine Antagonists, Humans, Therapeutic Irrigation, Nasal Polyps, Quality of Life, Sinusitis, Sodium Chloride, Macrolides, Leukotriene Antagonists, Maintenance Chemotherapy
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