Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Dec 2;2013(12):CD005149.
doi: 10.1002/14651858.CD005149.pub4.

Intranasal steroids for acute sinusitis

Anca Zalmanovici Trestioreanu  1 , John Yaphe
Affiliations
Meta-Analysis

Intranasal steroids for acute sinusitis

Anca Zalmanovici Trestioreanu et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school.

Objectives: We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children.

Search methods: We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies.

Selection criteria: Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work.

Data collection and analysis: Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus.

Main results: No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS.

Authors' conclusions: Current evidence is limited for acute sinusitis confirmed by radiology or nasal endoscopy but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 1 Proportion of participants with resolution of symptoms or improved (MFNS 400 µg daily).
1.2
1.2. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 2 Proportion of participants with resolution of symptoms or improved (MFNS 200 µg daily).
1.3
1.3. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 3 Proportion of participants with resolution of symptoms or improved (combined MFNS 200, 400 and 800 µg daily).
1.4
1.4. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 4 Number of participants that dropped out from the study (MFNS 400 µg daily).
1.5
1.5. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 5 Number of participants that dropped out from the study (MFNS 200 µg daily).
1.6
1.6. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 6 Number of participants that dropped out from the study (combined MFNS 200, 400 and 800 µg daily).
1.7
1.7. Analysis
Comparison 1 Intranasal corticosteroids versus placebo, Outcome 7 Relapse (combined 200 and 400 µg daily).
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Barlan 1997 {published data only}
    1. Barlan IB, Erkan E, Bakir M, Berrak S, Basaran MM. Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Annals of Allergy, Asthma & Immunology 1997;78:598‐601. - PubMed
Dolor 2001 {published data only}
    1. Dolor RJ, Witsell DL, Hellkamp AS, Williams JW, Califf RM, Simel DL. Comparison of cefuroxime with or without intranasal fluticasone for the treatment of rhinosinusitis. The CAFFS Trial: a randomized controlled trial. JAMA 2001;286:3097‐105. - PubMed
Meltzer 2005 {published data only}
    1. Meltzer EO, Bachert C, Staudinger H. Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin and placebo. Journal of Allergy and Clinical Immunology 2005;116(6):1289‐95. - PubMed
Nayak 2002 {published data only}
    1. Nayak AS, Settipane GA, Pedinoff A, Charous BL, Meltzer EO, Busse WW, et al. Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis. Annals of Allergy, Asthma & Immunology 2002;89:271‐8. - PubMed

References to studies excluded from this review

Bachert 2007 {published data only}
    1. Bachert C, Meltzer EO. Effect of mometasone furoate nasal spray on quality of life of patients with acute rhinosinusitis. Rhinology 2007;45(3):190‐6. - PubMed
Gehanno 2000 {published data only}
    1. Gehanno P, Beauvillain C, Bobin S, Chobaut JC, Desaulty A, Dubreuil C, et al. Short therapy with amoxicillin‐clavulanate and corticosteroids in acute sinusitis: results of a multicentre study in adults. Scandinavian Journal of Infectious Diseases 2000;32:679‐84. - PubMed
Jurkiewicz 2004 {published data only}
    1. Jurkiewicz D, Zielnik‐Jurkiewicz B. Intranasal corticosteroid in the treatment of acute sinusitis. 5th European Congress of Oto‐Rhino‐Laryngology Head and Neck Surgery (EUFOS). 2004.
Meltzer 1993 {published data only}
    1. Meltzer EO, Orgel HA, Backhaus JW, Busse WW, Druce HM, Metzger J, et al. Intranasal flunisolide spray as an adjunct to oral antibiotic therapy for sinusitis. Journal of Allergy and Clinical Immunology 1993;92:812‐23. - PubMed
Meltzer 2000 {published data only}
    1. Meltzer EO, Charous BL, Busse WW, Zinreich SJ, Lorber RR, Danzig MR, et al. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. Journal of Allergy and Clinical Immunology 2000;106:630‐7. - PubMed
Quarnberg 1992 {published data only}
    1. Quarnberg Y, Kantola O, Salo J, Toivanen M, Valtonen H, Vuori E. Influence of topical steroid treatment on maxillary sinusitis. Rhinology 1992;30:103‐12. - PubMed
Tutkun 1996 {published data only}
    1. Tutkun A, Inanli S, Batman C, Uneri C, Sehitoglu MA. The impact of intranasal steroid as an adjunct to therapy for sinusitis. Marmara Medical Journal 1996;9(1):11‐4.
Williamson 2007 {published data only}
    1. Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis. JAMA 2007;298(21):2487‐96. - PubMed
Yilmaz 2000 {published data only}
    1. Yilmaz G, Varan B, Yilmaz T, Gurakan B. Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. European Archives of Oto‐rhino‐laryngology 2000;257(5):256‐9. - PubMed

Additional references

Ahovuo‐Saloranta 2011
    1. Ahovuo‐Saloranta A, Rautakorpi UM, Borisenko OV, Liira H, Williams Jr JW, Makela M. Antibiotics for acute maxillary sinusitis. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD000243.pub2] - DOI - PubMed
Allen 2000
    1. Allen DB. Do intranasal corticosteroids affect childhood growth?. Allergy 2000;55(Suppl 62):15‐8. - PubMed
Becker 2003
    1. Becker DG. Medical treatment of sinusitis. Journal of Long‐term Effects of Medical Implants 2003;13(3):195‐205. - PubMed
Benninger 1997
    1. Benninger MS, Anon J, Mabry RL. The medical management of rhinosinusitis. Otolaryngology ‐ Head and Neck Surgery 1997;117(3 Pt 2):S41‐9. - PubMed
Brannan 1997
    1. Brannan MD, Herron JM, Affrime MB. Safety and tolerability of once‐daily mometasone furoate aqueous nasal spray in children. Clinical Therapeutics 1997;19:1330‐9. - PubMed
Cable 2000
    1. Cable BB, Wassmuth Z, Mann EA, Hommer D, Connely G, Klem C, et al. The effect of corticosteroids in the treatment of experimental sinusitis. American Journal of Rhinology 2000;14(4):217‐22. - PubMed
Contopoulos 2003
    1. Contopoulos‐Ioannidis DG, Ioannidis JP, Lau J. Acute sinusitis in children: current treatment strategies. Paediatric Drugs 2003;5(2):71‐80. - PubMed
Corren 1999
    1. Corren J. Intranasal corticosteroids for allergic rhinitis: how do different agents compare?. Journal of Allergy and Clinical Immunology 1999;104(4 Pt 1):S144‐9. - PubMed
Davies 1997
    1. Davies RJ, Nelson HS. Once‐daily mometasone furoate nasal spray: efficacy and safety of a new intranasal glucocorticoid for allergic rhinitis. Clinical Therapeutics 1997;19:27‐38. - PubMed
Druce 1990
    1. Druce HM. Adjuncts to medical management of sinusitis. Otolaryngology ‐ Head and Neck Surgery 1990;103:880‐3. - PubMed
Druce 1991
    1. Druce HM, Slavin RG. Sinusitis: critical need for further study. Journal of Allergy and Clinical Immunology 1991;88:675‐7. - PubMed
Galant 2001
    1. Galant SP, Wilkinson R. Clinical prescribing of allergic rhinitis medication in the preschool and young school‐age child: what are the options?. BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy 2001;15(7):453‐63. - PubMed
Gawchik 2000
    1. Gawchik SM, Saccar CL. A risk‐benefit assessment of intranasal triamcinolone acetonide in allergic rhinitis. Drug Safety 2000;23(4):309‐22. - PubMed
Gwaltney 1994
    1. Gwaltney JM, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. New England Journal of Medicine 1994;330(1):25‐30. - PubMed
Gwaltney 1995
    1. Gwaltney JM Jr, Jones JG, Kennedy DW. Medical management of sinusitis: educational goals and management guidelines: the International Conference on Sinus Disease. Annals of Otology, Rhinology and Laryngology Supplement 1995;167:22‐30. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. Chichester, UK: Wiley‐Blackwell.
Juniper 1990
    1. Juniper EF, Guyatt GH, O'Byrne PM, Viveiros M. Aqueous beclomethasone dipropionate nasal spray: regular versus "as required" use in the treatment of seasonal allergic rhinitis. Journal of Allergy and Clinical Immunology 1990;86:380‐6. - PubMed
Kaliner 1997
    1. Kaliner MA, Osguthorpe JD, Fireman P, Anon J, Georgitis J, Davis ML, et al. Sinusitis: bench to bedside. Current findings, future directions. Journal of Allergy and Clinical Immunology 1997;99(Suppl):829‐48. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www.cochrane‐handbook.org. Chichester: Wiley‐Blackwell, 2011.
Little 2000
    1. Little DR, Mann BL, Godbout CJ. How family physicians distinguish acute sinusitis from upper respiratory tract infections: a retrospective analysis. Journal of the American Board of Family Practice 2000;13(2):101‐6. - PubMed
Mucha 2003
    1. Mucha SM, Baroody FM. Sinusitis update. Current Opinion in Allergy and Clinical Immunology 2003;3(1):33‐8. - PubMed
Mygind 1976
    1. Mygind N, Prytz S, Sorensen H, Pedersen CB. Long term treatment of nasal polyps with beclomethasone dipropionate aerosol. Treatment and rationale. Acta Otolaryngologica (Stockholm) 1976;82:252‐5. - PubMed
Mygind 2001
    1. Mygind N, Nielsen LP, Hoffmann HJ, Shukla A, Blumberga G, Dahl R, et al. Mode of action of intranasal corticosteroids. Journal of Allergy and Clinical Immunology 2001;108(Suppl 1):16‐25. - PubMed
Piccirillo 2001
    1. Piccirillo JF, Mager D, Frisse M, Brophy RH, Goggin A. Impact of first‐line vs. second‐line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA 2001;286(15):1849‐56. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Sahay 1980
    1. Sahay JN, Ibrahim NBN, Chatterjee SS, Nassar WY, Lodge KV, Jones CW. Long term study of flunisolide treatment in perennial rhinitis with special reference to nasal mucosal histology and morphology. Clinical Allergy 1980;10:451‐7. - PubMed
Scadding 2000
    1. Scadding GK. Other anti‐inflammatory uses of intranasal corticosteroids in upper respiratory inflammatory diseases. Allergy 2000;55(Suppl 62):19‐23. - PubMed
Schenkel 2000
    1. Schenkel EJ, Skoner DP, Bronsky EA, Miller SD, Pearlman DS, Rooklin A. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000;105:E22. - PubMed
Seigel 1988
    1. Seigel SC. Topical intranasal corticosteroid therapy in rhinitis. Journal of Allergy and Clinical Immunology 1988;81:984‐91. - PubMed
Shaikh 2012
    1. Shaikh N, Wald ER, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD007909.pub3] - DOI - PubMed
Shapiro 1992
    1. Shapiro GG, Rachelefski GS. Introduction and definition of sinusitis. Journal of Allergy and Clinical Immunology 1992;90:417‐8. - PubMed
Shrum 2001
    1. Shrum KM, Grogg SE, Barton P, Shaw HH, Dyer RR. Sinusitis in children: the importance of diagnosis and treatment. Journal of the American Osteopathic Association 2001;101(Suppl 5):8‐13. - PubMed
Slavin 2005
    1. Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. Journal of Allergy and Clinical Immunology 2005;116(Suppl 6):13‐47. - PubMed
Snow 2001
    1. Snow V, Mottur‐Pilson C, Hickner JM. Principles of appropriate antibiotic use for acute sinusitis in adults. Annals of International Medicine 2001;134(6):495‐7. - PubMed
Spector 1998
    1. Spector SL, Bernstein IL, Li JT, Berger WE, Kaliner MA, Schuller DE, et al. Parameters for the diagnosis and management of sinusitis. Journal of Allergy and Clinical Immunology 1998;102(Suppl):107‐44. - PubMed
Venekamp 2011
    1. Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Mar CB, Perera R, et al. Systemic corticosteroids for acute sinusitis. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD008115.pub2] - DOI - PubMed
Wald 1988
    1. Wald ER. Sinusitis in children. Pediatric Infectious Disease Journal 1988;7(Suppl 11):150‐3. - PubMed
Williams 1993
    1. Williams JW Jr, Simel DL. Practice variation for managing acute sinusitis. Clinical Research 1993;41:566A.
Winstead 2003
    1. Winstead W. Rhinosinusitis. Primary Care 2003;30(1):137‐54. - PubMed
Winther 1990
    1. Winther B, Gwaltney JM Jr. Therapeutic approach to sinusitis: antiinfectious therapy as the baseline of management. Otolaryngology ‐ Head and Neck Surgery 1990;103(5 (Pt 2)):876‐9. - PubMed
Zeiger 1992
    1. Zeiger RS. Prospects for ancillary treatment of sinusitis in the 1990s. Journal of Allergy and Clinical Immunology 1992;90:478‐95. - PubMed

References to other published versions of this review

Zalmanovici 2007
    1. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD005149.pub2] - DOI - PubMed
Zalmanovici 2009
    1. Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD005149.pub3] - DOI - PubMed
Zalmanovici Trestioreanu 2011
    1. Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2011, Issue 8. [DOI: 10.1002/14651858.CD005149.pub3] - DOI - PMC - PubMed

Substances

LinkOut - more resources