Richard J Harvey1,2, Kornkiat Snidvongs2,3, Larry H Kalish4,5, Gretchen M Oakley1,6, Raymond Sacks2,4,5. 1. Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia. 2. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 3. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 4. Sydney Medical School, University of Sydney, Sydney, Australia. 5. Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, Sydney, Australia. 6. Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT.
Abstract
BACKGROUND: Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. METHODS: The objective was to determine if corticosteroid delivered via a nasal irrigation or via a simple nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a nasal irrigation followed by a nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinonasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. RESULTS:A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid nasal irrigation group had greater improvement in nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid irrigation group. CONCLUSION: In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by nasal irrigation is superior to simple nasal spray in postsurgical patients.
RCT Entities:
BACKGROUND: Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. METHODS: The objective was to determine if corticosteroid delivered via a nasal irrigation or via a simple nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a nasal irrigation followed by a nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinonasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. RESULTS: A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid nasal irrigation group had greater improvement in nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid irrigation group. CONCLUSION: In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by nasal irrigation is superior to simple nasal spray in postsurgical patients.
Authors: Tuong T Nguyen; Paul S Soma; Teresa Mascenik; Catherine A Lewis; Rhianna E Lee; Brian D Thorp; Adam M Zanation; Charles S Ebert; Brent A Senior; Scott H Randell; Brandie M Ehrmann; Adam J Kimple Journal: Int Forum Allergy Rhinol Date: 2019-10-21 Impact factor: 3.858
Authors: Pawina Jiramongkolchai; Andrew Peterson; Dorina Kallogjeri; Jake J Lee; Sara Kukuljan; Adam Liebendorfer; John S Schneider; Cristine N Klatt-Cromwell; Andrew J Drescher; Jay F Piccirillo Journal: Int Forum Allergy Rhinol Date: 2020-05-29 Impact factor: 3.858
Authors: Atsushi Kato; Anju T Peters; Whitney W Stevens; Robert P Schleimer; Bruce K Tan; Robert C Kern Journal: Allergy Date: 2021-09-15 Impact factor: 14.710
Authors: Matthew L Coates; Lisa C Willcocks; Pasupathy Sivasothy; Marcos Martinez Del Pero Journal: Rheumatology (Oxford) Date: 2021-06-17 Impact factor: 7.046
Authors: Robert Naclerio; Fuad Baroody; Claus Bachert; Benjamin Bleier; Larry Borish; Erica Brittain; Geoffrey Chupp; Anat Fisher; Wytske Fokkens; Philippe Gevaert; David Kennedy; Jean Kim; Tanya M Laidlaw; Jake J Lee; Jay F Piccirillo; Jayant M Pinto; Lauren T Roland; Robert P Schleimer; Rodney J Schlosser; Julie M Schwaninger; Timothy L Smith; Bruce K Tan; Ming Tan; Elina Toskala; Sally Wenzel; Alkis Togias Journal: J Allergy Clin Immunol Pract Date: 2020-03-04