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
. 2016 Apr 26;4(4):CD011993.
doi: 10.1002/14651858.CD011993.pub2.

Different types of intranasal steroids for chronic rhinosinusitis

Lee Yee Chong  1 , Karen Head, Claire Hopkins, Carl Philpott, Martin J Burton, Anne G M Schilder
Affiliations

Different types of intranasal steroids for chronic rhinosinusitis

Lee Yee Chong et al. Cochrane Database Syst Rev. .

Abstract

Background: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Topical (intranasal) corticosteroids are used with the aim of reducing inflammation in the sinonasal mucosa in order to improve patient symptoms.

Objectives: To assess the effects of different types of intranasal steroids in people with chronic rhinosinusitis.

Search methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 7); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 11 August 2015.

Selection criteria: Randomised controlled trials (RCTs) with a follow-up period of at least three months comparing first-generation intranasal corticosteroids (e.g. beclomethasone dipropionate, triamcinolone acetonide, flunisolide, budesonide) with second-generation intranasal corticosteroids (e.g. ciclesonide, fluticasone furoate, fluticasone propionate, mometasone furoate, betamethasone sodium phosphate), or sprays versus drops, or low-dose versus high-dose intranasal corticosteroids.

Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the commonest adverse event - epistaxis (nosebleed). Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse event of local irritation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.

Main results: We included nine RCTs (911 participants), including four different comparisons. None of the studies evaluated our first primary outcome measure, disease-specific HRQL. Fluticasone propionate versus beclomethasone dipropionate We identified two small studies (56 participants with polyps) that evaluated disease severity and looked at the primary adverse effect: epistaxis , but no other outcomes. We cannot report any numerical data but the study authors reported no difference between the two steroids. The evidence was of very low quality. Fluticasone propionate versus mometasone furoate We identified only one study (100 participants with polyps) that evaluated disease severity (nasal symptoms scores), which reported no difference (no numerical data available). The evidence was of very low quality. High-dose versus low-dose steroidsWe included five studies (663 participants with nasal polyps), three using mometasone furoate (400 µg versus 200 µg in adults and older children, 200 µg versus 100 µg in younger children) and two using fluticasone propionate drops (800 µg versus 400 µg). We found low quality evidence relating to disease severity and nasal polyps size, with results from the high-dose and low-dose groups being similar. Although all studies reported more improvement in polyp score in the high-dose group, the significance of this is unclear due to the small size of the improvements.The primary adverse effect, epistaxis , was more common when higher doses were used (risk ratio (RR) 2.06, 95% confidence interval (CI) 1.20 to 3.54, 637 participants, moderate quality evidence). Most of the studies that contributed data to this outcome used a broad definition of epistaxis, which ranged from frank bleeding to bloody nasal discharge to flecks of blood in the mucus. Aqueous nasal spray versus aerosol spray We identified only one poorly reported study (unclear number of participants for comparison of interest, 91 between three treatment arms), in which there were significant baseline differences between the participants in the two groups. We were unable to draw meaningful conclusions from the data.

Authors' conclusions: We found insufficient evidence to suggest that one type of intranasal steroid is more effective than another in patients with chronic rhinosinusitis, nor that the effectiveness of a spray differs from an aerosol. We identified no studies that compared drops with spray.It is unclear if higher doses result in better symptom improvements (low quality evidence), but there was moderate quality evidence of an increased risk of epistaxis as an adverse effect of treatment when higher doses were used. This included all levels of severity of epistaxis and it is likely that the proportion of events that required patients to discontinue usage is low due to the low numbers of withdrawals attributed to it. If epistaxis is limited to streaks of blood in the mucus it may be tolerated by the patient and it may be safe to continue treatment. However, it may be a factor that affects compliance.There is insufficient evidence to suggest that the different types of corticosteroid molecule or spray versus aerosol have different effects. Lower doses have similar effectiveness but fewer side effects.Clearly more research in this area is needed, with specific attention given to trial design, disease-specific health-related quality of life outcomes and evaluation of longer-term outcomes and adverse effects.

PubMed Disclaimer

Conflict of interest statement

Lee Yee Chong: none known.

Karen Head: none known.

Claire Hopkins: I have received financial support from several companies involved in producing instruments for sinus surgery: Acclarent, Sinusys, Cryolife and Medtronic.

Carl Philpott: I have previously received consultancy fees from the companies Acclarent, Navigant, Aerin Medical and Entellus.

Martin J Burton: Professor Martin Burton is joint Co‐ordinating Editor of Cochrane ENT, but had no role in the editorial process for this review.

Anne GM Schilder: Professor Anne Schilder is joint Co‐ordinating Editor of Cochrane ENT, but had no role in the editorial process for this review. Her evidENT team at UCL is supported by her NIHR Research Professorship award with the remit to develop a UK infrastructure and programme of clinical research in ENT, Hearing and Balance. Her institution has received a grant from GSK for a study on the microbiology of acute tympanostomy tube otorrhoea.

Figures

1
1
Process for sifting search results and selecting studies for inclusion.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 High‐dose versus low‐dose intranasal corticosteroids, outcome: 1.1 Disease severity ‐ overall symptoms, measured as average change from baseline at 4 months (range 0 to 3).
5
5
Forest plot of comparison: 1 High‐dose versus low‐dose intranasal corticosteroids, outcome: 1.2 Disease severity ‐ individual symptoms, measured as average change from baseline at 4 months (range 0 to 3).
1.1
1.1. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 1 Disease severity ‐ overall symptoms, measured as average change from baseline at 4 months (range 0 to 3).
1.2
1.2. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 2 Disease severity ‐ individual symptoms, measured as average change from baseline at 4 months (range 0 to 3).
1.3
1.3. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 3 Adverse effects: epistaxis.
1.4
1.4. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 4 Adverse effects: local irritation.
1.5
1.5. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 5 Nasal polyps size, measured as change from baseline (0 to 3 range scale) at 4 months.
1.6
1.6. Analysis
Comparison 1 High‐dose versus low‐dose intranasal corticosteroids, Outcome 6 Nasal polyps ‐ proportion with improvement at 12 weeks.
See this image and copyright information in PMC

Comment in

  • Cochrane Corner: Extracts from The Cochrane Library.
    Orlandi R, Hopkins C, Philpott C, Rosenfeld RM. Orlandi R, et al. Otolaryngol Head Neck Surg. 2017 Mar;156(3):397-402. doi: 10.1177/0194599816680605. Epub 2016 Dec 20. Otolaryngol Head Neck Surg. 2017. PMID: 28248603

References

References to studies included in this review

Chur 2013 {published data only}
    1. Chur V, Small CB, Stryszak P, Teper A. Mometasone furoate nasal spray is safe for the treatment of nasal polyps in pediatric subjects 6‐17 years of age. Journal of Allergy & Clinical Immunology 2010;25(Suppl 2):AB101.
    1. Chur V, Small CB, Stryszak P, Teper A. Safety of mometasone furoate nasal spray in the treatment of nasal polyps in children. Pediatric Allergy and Immunology 2013;24(1):33‐8. [PUBMED: 23331528] - PubMed
Demirel 2008 {published data only}
    1. Demirel T, Orhan KS, Keles N, Deger K. Comparison of the efficacy of nasal drop and nasal spray applications of fluticasone propionate in nasal polyps. Kulak Burun Bogaz Ihtisas Dergisi: KBB [Journal of Ear, Nose, and Throat] 2008;18(1):1‐6. [PUBMED: 18443395] - PubMed
Filipovic 2006 {published data only}
    1. Filipovic MD, Cekic SS. A comparison of fluticasone propionate (FP) and mometasone furoate (MF) nasal spray in the treatment of nasal polyposis associated with asthma [Abstract]. European Respiratory Society International Congress; 2006 Sep 2‐6; Munich, Germany. 2006:314s.
Holmberg 1997 {published data only}
    1. Holmberg K, Juliusson S, Balder B, Smith DL, Richards DH, Karlsson G. Fluticasone propionate aqueous nasal spray in the treatment of nasal polyposis. Annals of Allergy, Asthma, and Immunology 1997;78(3):270‐6. [PUBMED: 9087151] - PubMed
Johansen 1993 {published data only}
    1. Vendelo Johansen L, Illum P, Kristensen S, Winther L, Vang Petersen S, Synnerstad B. The effect of budesonide (Rhinocort) in the treatment of small and medium‐sized nasal polyps. Clinical Otolaryngology and Allied Sciences 1993;18(6):524‐7. [PUBMED: 8877234] - PubMed
Lund 1998 {published data only}
    1. Lund VJ, Flood J, Sykes AP, Richards DH. Effect of fluticasone in severe polyposis. Archives of Otolaryngology ‐‐ Head and Neck Surgery 1998;124(5):513‐8. [PUBMED: 9604976] - PubMed
Penttila 2000 {published data only}
    1. Penttila M, Holstrom M, Poulsen P, Hollingworth K. The efficacy and tolerability of fluticasone propionate (FP) nasal drops 400fig once daily and twice daily compared with placebo in the treatment of nasal polyposis. Allergy 1998;53(Suppl 43):109.
    1. Penttila M, Poulsen P, Hollingworth K, Holmstrom M. Dose‐related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo‐controlled randomized study in adult patients. Clinical and Experimental Allergy 2000;30(1):94‐102. [PUBMED: 10606936] - PubMed
Small 2005 {published data only}
    1. Bloom M, Staudinger H. Effect of mometasone furoate nasal spray (MFNS) on nasal polyposis. Journal of Allergy and Clinical Immunology 2004;113(2 Suppl):S282.
    1. Bloom M, Staudinger H. Effect of mometasone furoate nasal spray on nasal polyposis. Proceedings of the XXIII Congress of the European Academy of Allergology and Clinical Immunology (EAACI); 2004 Jun 12‐16; Amsterdam, The Netherlands. 2004:Abstract No 279.
    1. Small CB, Hernandez J, Reyes A, Schenkel E, Damiano A, Stryszak P, et al. Efficacy and safety of mometasone furoate nasal spray in nasal polyposis. Journal of Allergy and Clinical Immunology 2005;116(6):1275‐81. [PUBMED: 16337459] - PubMed
Stjarne 2006 {published data only}
    1. Bloom M, Staudinger H. Effect of mometasone furoate nasal spray (MFNS) on nasal polyposis. Journal of Allergy and Clinical Immunology 2004;113(2 Suppl):S282.
    1. Bloom M, Staudinger H. Effect of mometasone furoate nasal spray on nasal polyposis. Proceedings of the XXIII Congress of the European Academy of Allergology and Clinical Immunology (EAACI); 2004 Jun 12‐16; Amsterdam, The Netherlands. 2004:Abstract No 279.
    1. Stjarne P, Mosges R, Jorissen M, Passali D, Bellussi L, Staudinger H, et al. A randomized controlled trial of mometasone furoate nasal spray for the treatment of nasal polyposis. Archives of Otolaryngology ‐‐ Head and Neck Surgery 2006;132(2):179‐85. [PUBMED: 16490876] - PubMed

References to studies excluded from this review

Bross‐Soriano 2004 {published data only}
    1. Bross‐Soriano D, Arrieta‐Gomez JR, Prado‐Calleros H. Infections after endoscopic polypectomy using nasal steroids. Otolaryngology ‐ Head and Neck Surgery 2004;130(3):319‐22. - PubMed
Cannady 2005 {published data only}
    1. Cannady SB, Batra PS, Citardi MJ, Lanza DC. Comparison of delivery of topical medications to the paranasal sinuses via "vertex‐to‐floor" position and atomizer spray after FESS. Otolaryngology ‐ Head and Neck Surgery 2005;133(5):735‐40. - PubMed
Dijkstra 2004 {published data only}
    1. Dijkstra MD, Ebbens FA, Poublon RML, Fokkens WJ. Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery. Clinical and Experimental Allergy 2004;34(9):1395‐400. - PubMed
    1. Dijkstra MD, Poublon RML, Fokkens WJ. The role of topical corticosteroids after functional endoscopic sinus surgery for chronic sinusitis and/or nasal polyps. Clinical Otolaryngology and Allied Sciences 2001;26(4):341‐2.
Filiaci 2000 {published data only}
    1. Filiaci F, Passali D, Puxeddu R, Schrewelius C. A randomized controlled trial showing efficacy of once daily intranasal budesonide in nasal polyposis. Rhinology 2000;38(4):185‐90. - PubMed
Fowler 2002 {published data only}
    1. Fowler PD, Gazis AG, Page SR, Jones NS. A randomized double‐blind study to compare the effects of nasal fluticasone and betamethasone on the hypothalamo‐pituitary‐adrenal axis and bone turnover in patients with nasal polyposis. Clinical Otolaryngology and Allied Sciences 2002;27(6):489‐93. - PubMed
Giger 2003 {published data only}
    1. Giger R, Pasche P, Cheseaux C, Cantini L, Rossetti A, Landis BN, et al. Comparison of once‐ versus twice‐daily use of beclomethasone dipropionate aqueous nasal spray in the treatment of allergic and non‐allergic chronic rhinosinusitis. European Archives of Oto‐Rhino‐Laryngology 2003;260(3):135‐40. [PUBMED: 12687385] - PubMed
Jankowski 2001 {published data only}
    1. Jankowski R, Schrewelius C, Bonfils P, Saban Y, Gilain L, Prades JM, et al. Efficacy and tolerability of budesonide aqueous nasal spray treatment in patients with nasal polyps. Archives of Otolaryngology‐‐Head & Neck Surgery 2001;127(4):447‐52. - PubMed
Keith 1995 {published data only}
    1. Keith PK, Conway M, Evans S, Edney P, Jennings B, Anderson B, et al. A double‐blind comparison of intranasal budesonide dry powder vs placebo in nasal polyposis. Journal of Allergy and Clinical Immunology 1995;95(1 Part 2):204.
Lildholdt 1995 {published data only}
    1. Lildholdt T, Rundcrantz H, Lindqvist N. Efficacy of topical corticosteroid powder for nasal polyps: a double‐blind, placebo‐controlled study of budesonide. Clinical Otolaryngology and Allied Sciences 1995;20(1):26‐30. - PubMed
NCT00788463 {published and unpublished data}
    1. NCT00788463. A comparison of beclomethasone aqueous spray and aerosol delivery systems in nasal polyps. https://clinicaltrials.gov/show/NCT00788463 (accessed 27 February 2016). - PMC - PubMed
NCT01405339 {published data only}
    1. NCT01405339. Budesonide application via mucosal atomization device as a treatment for chronic rhinosinusitis when utilized as a topical nasal steroid spray. https://clinicaltrials.gov/show/NCT01405339 (accessed 22 February 2016).
NCT01623310 {published data only}
    1. IncOu, NCT01623310. Study evaluating the safety of intranasal administration of 400 μg of fluticasone propionate twice a day (bid) using a novel bi‐directional device in subjects with chronic sinusitis with or without nasal polyps. https://clinicaltrials.gov/show/NCT01623310 (accessed 22 February 2016).
NCT02194062 {published data only}
    1. NCT02194062. Comparison of nasal steroids after FESS in CRSwNP. https://clinicaltrials.gov/show/NCT02194062 (accessed on 27 February 2016).
Raghavan 2006 {published data only}
    1. Raghavan U, Jones NS. A prospective randomized blinded cross‐over trial using nasal drops in patients with nasal polyposis: an evaluation of effectiveness and comfort level of two head positions. American Journal of Rhinology 2006;20(4):397‐400. - PubMed
Reychler 2015 {published data only}
    1. Reychler G, Colbrant C, Huart C, Guellec S, Vecellio L, Liistro G, et al. Effect of three‐drug delivery modalities on olfactory function in chronic sinusitis. Laryngoscope 2015;125(3):549‐55. - PubMed
    1. Reychler G, Colbrant C, Huart C, Guellec S, Vecellio L, Rombaux P. Comparison of three modalities of corticosteroids administration in chronic rhinosinusitis. European Respiratory Journal 2014;44 Suppl 58:Abstract.
Singhal 2008 {published data only}
    1. Singhal D, Hissaria P, Smith W. Three methods of delivery of nasal corticosteroids in chronic sinusitis: a pilot study. Internal Medicine Journal 2008;38(S6):A154.
Toft 1982 {published data only}
    1. Toft A, Wihl JA, Toxman J, Mygind N. Double‐blind comparison between beclomethasone dipropionate as aerosol and as powder in patients with nasal polyposis. Clinical Allergy 1982;12(4):391‐401. - PubMed
    1. Wihl JA. Topical corticosteroids and nasal reactivity. European Journal of Respiratory Diseases 1982;122:205‐10. - PubMed
Tos 1998 {published data only}
    1. Tos M, Svendstrup F, Arndal H, Orntoft S, Jakobsen J, Borum P, et al. Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps. American Journal of Rhinology 1998;12(3):183‐9. - PubMed
Wang 2012 {published data only}
    1. Wang C, Lou H, Lou W, Zhang L. The efficacy and safety of a short course of budesonide inhalation suspension via transnasal nebulization in chronic rhinosinusitis with nasal polyps. Lin chuang er bi yan hou tou jing wai ke za zhi [Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery] 2012;26(8):347‐50. - PubMed

References to studies awaiting assessment

Bachert 2004 {published data only}
    1. Bachert C. Efficacy of budesonide powder treatments in nasal polyposis. Proceedings of the 3rd International Consensus Conference on Nasal Polyposis. 2004 Apr 23‐25; Brussels, Belgium. 2004.
Meln 2004 {published data only}
    1. Meln I, Johansson L, Holmberg K, Stierna P, Bende M. Results from treatment with topical steroids. Proceedings of the 3rd International Consensus Conference on Nasal Polyposis; 2004 23‐25 Apr; Brussels, Belgium. 2004:335.
Pisano 2000 {published data only}
    1. Pisano G. Management of nasal polyposis: efficacy of intranasal corticosteroid with hypertonic solution. Proceedings of the XVIII Congress of European Rhinologic Society and XIX International Symposium on Infection and Allergy of the Nose; 2000 25‐29 Jun; Barcelona, Spain. 2000:Abstract No. 414.
Reim 2005 {published data only}
    1. Reim L. Mometasone furoate for the treatment of nasal polyps. Medizinische Welt 2005;56:224.

References to ongoing studies

NCT01622569 {published data only}
    1. NCT01622569. Study evaluating the efficacy and safety of intranasal administration of 100, 200, and 400 μg of fluticasone propionate twice a day (bid) using a novel bi directional device in subjects with bilateral nasal polyposis followed by an 8‐week open‐label extension phase to assess safety. https://clinicaltrials.gov/show/NCT01622569 (accessed 27 February 2016).
NCT01624662 {published data only}
    1. NCT01624662. Efficacy and safety study of intranasal administration of 100, 200, and 400 μg of fluticasone propionate twice a day (bid) using a novel bi directional device in subjects with bilateral nasal polyposis followed by an 8‐week open‐label extension phase to assess safety. https://clinicaltrials.gov/show/NCT01624662 (accessed 27 February 2016).
NCT01946711 {published and unpublished data}
    1. NCT01946711. A randomised, open, controlled pilot study to investigate the efficacy and safety of Buparid/PARI SINUS versus Budes® nasal spray in the therapy of chronic rhinosinusitis (CRS) with polyposis nasi in adult patients. https://clinicaltrials.gov/ct2/show/NCT01946711 (accessed 27 February 2016).

Additional references

Balk 2012
    1. Balk EM, Earley A, Patel K, Trikalinos TA, Dahabreh IJ. Empirical assessment of within‐arm correlation imputation in trials of continuous outcomes [Internet]. Report No.: 12(13)‐EHC141‐EF. AHRQ Methods for Effective Health Care. Rockville (MD): Agency for Healthcare Research and Quality, 2012. - PubMed
Benninger 2003
    1. Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngology ‐ Head and Neck Surgery 2003;129(Suppl 3):S1‐32. - PubMed
Cho 2012
    1. Cho SH, Hong SJ, Han B, Lee SH, Suh L, Norton J, et al. Age‐related differences in the pathogenesis of chronic rhinosinusitis. Journal of Allergy and Clinical Immunology 2012;129(3):858‐60.e2. - PMC - PubMed
Chong 2016a
    1. Chong LY, Head K, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2016, Issue 4. [DOI: 10.1002/14651858.CD011996.pub2] - DOI - PMC - PubMed
Chong 2016b
    1. Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G, et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2016, Issue 4. [DOI: 10.1002/14651858.CD011995.pub2] - DOI - PMC - PubMed
Cohen 1988
    1. Cohen J. Statistical Power Analysis in the Behavioral Sciences. 2nd Edition. Hillsdale (NJ): Lawrence Erlbaum Associates, Inc., 1988.
DeMarcantonio 2011
    1. DeMarcantonio MA, Han JK. Nasal polyps: pathogenesis and treatment implications. Otolaryngologic Clinics of North America 2011;44(3):685‐95, ix. - PubMed
Ebbens 2010
    1. Ebbens FA, Toppila‐Salmi SK, Renkonen JA, Renkonen RL, Mullol J, Drunen CM, et al. Endothelial L‐selectin ligand expression in nasal polyps. Allergy 2010;65(1):95‐102. - PubMed
Ebbens 2011
    1. Ebbens FA, Toppila‐Salmi S, Groot EJ, Renkonen J, Renkonen R, Drunen CM, et al. Predictors of post‐operative response to treatment: a double blind placebo controlled study in chronic rhinosinusitis patients. Rhinology 2011;49(4):413‐9. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ (Clinical research ed.) 1997;315(7109):629‐34. [PUBMED: 9310563] - PMC - PubMed
EPOS 2012
    1. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology. Supplement 2012;50 Suppl 23:1‐298. - PubMed
Fokkens 2007
    1. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinology 2007;45(Suppl 20):1‐139. - PubMed
Gliklich 1995
    1. Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngology ‐ Head and Neck Surgery 1995;113(1):104‐9. - PubMed
Grobler 2008
    1. Grobler A, Weitzel EK, Buele A, Jardeleza C, Cheong YC, Field J, et al. Pre‐ and postoperative sinus penetration of nasal irrigation. Laryngoscope 2008;118(11):2078‐81. - PubMed
Hamilos 2000
    1. Hamilos DL. Chronic sinusitis. Journal of Allergy and Clinical Immunology 2000;106:213‐27. - PubMed
Handbook 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.
Harvey 2009
    1. Harvey RJ, Debnath N, Srubiski A, Bleier B, Schlosser RJ. Fluid residuals and drug exposure in nasal irrigation. Otolaryngology ‐ Head and Neck Surgery 2009;141(6):757‐61. - PubMed
Hastan 2011
    1. Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, et al. Chronic rhinosinusitis in Europe ‐ an underestimated disease. A GA2LEN study. Allergy 2011;66(9):1216‐23. - PubMed
Head 2016a
    1. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Short‐course oral steroids alone for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2016, Issue 4. [DOI: 10.1002/14651858.CD011991.pub2] - DOI - PMC - PubMed
Head 2016b
    1. Head K, Chong LY, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Short‐course oral steroids as an adjunct therapy for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2016, Issue 4. [DOI: 10.1002/14651858.CD011992.pub2] - DOI - PMC - PubMed
Head 2016c
    1. Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AGM, et al. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2016, Issue 4. [DOI: 10.1002/14651858.CD011994.pub2] - DOI - PMC - PubMed
Kalish 2012
    1. Kalish L, Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. Topical steroids for nasal polyps. Cochrane Database of Systematic Reviews 2012, Issue 12. [DOI: 10.1002/14651858.CD006549.pub2] - DOI - PubMed
Kern 2008
    1. Kern RC, Conley DB, Walsh W, Chandra R, Kato A, Tripathi‐Peters A, et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. American Journal of Rhinology 2008;22(6):549‐59. - PMC - PubMed
Keswani 2012
    1. Keswani A, Chustz RT, Suh L, Carter R, Peters AT, Tan BK, et al. Differential expression of interleukin‐32 in chronic rhinosinusitis with and without nasal polyps. Allergy 2012;67(1):25‐32. - PMC - PubMed
Larsen 2004
    1. Larsen P, Tos M. Origin of nasal polyps: an endoscopic autopsy study. Laryngoscope 2004;114(4):710‐9. - PubMed
McNally 1997
    1. McNally PA, White MW, Kaliner MA. Sinusitis in an allergists' office: analysis of 2000 consecutive cases. Allergy and Asthma Proceedings 1997;18:169‐75. - PubMed
Mullol 2009
    1. Mullol J. Corticosteroid treatment in chronic rhinosinusitis: the possibilities and the limits. Immunology and Allergy Clinics of North America 2009;29(4):657‐68. - PubMed
Ragab 2004
    1. Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope 2004;114(5):923‐30. - PubMed
Ragab 2010
    1. Ragab SM, Lund VJ, Scadding G, Saleh HA, Khalifa MA. Impact of chronic rhinosinusitis therapy on quality of life: a prospective randomized controlled trial. Rhinology 2010;48(3):305‐11. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Snidvongs 2011
    1. Snidvongs K, Kalish L, Sacks R, Craig JC, Harvey RJ. Topical steroid for chronic rhinosinusitis without polyps. Cochrane Database of Systematic Reviews 2011, Issue 8. [DOI: 10.1002/14651858.CD009274] - DOI - PubMed
Soler 2010
    1. Soler ZM, Smith TL. Quality‐of‐life outcomes after endoscopic sinus surgery: how long is long enough?. Otolaryngology ‐ Head and Neck Surgery 2010;143(5):621‐5. - PMC - 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(6 Pt 2):S107‐44. - PubMed
Tan 2011
    1. Tan BK, Li QZ, Suh L, Kato A, Conley DB, Chandra RK, et al. Evidence for intranasal antinuclear autoantibodies in patients with chronic rhinosinusitis with nasal polyps. Journal of Allergy and Clinical Immunology 2011;128(6):1198‐206.e1. - PMC - PubMed
Thomas 2013
    1. Thomas WW 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ. Distribution of topical agents to the paranasal sinuses: an evidence‐based review with recommendations. International Forum of Allergy and Rhinology 2013;3(9):691‐703. - PubMed
Tomassen 2011
    1. Tomassen P, Zele T, Zhang N, Perez‐ Novo C, Bruaene N, Gevaert P, et al. Pathophysiology of chronic rhinosinusitis. Proceedings of the American Thoracic Society 2011;8(1):115‐20. - PubMed
van Drunen 2009
    1. Drunen CM, Reinartz SM, Wigman J, Fokkens W. Inflammation in chronic rhinosinusitis and nasal polyposis. Immunology and Allergy Clinics of North America 2009;29(4):621‐9. - PubMed
Zhang 2008
    1. Zhang N, Zele T, Perez‐Novo C, Bruaene N, Holtappels G, DeRuyck N, et al. Different types of T‐effector cells orchestrate mucosal inflammation in chronic sinus disease. Journal of Allergy and Clinical Immunology 2008;122(5):961‐8. - PubMed
Zhang 2009
    1. Zhang XH, Lu X, Long XB, You XJ, Gao QX, Cui YH, et al. Chronic rhinosinusitis with and without nasal polyps is associated with decreased expression of glucocorticoid‐induced leucine zipper. Clinical and Experimental Allergy 2009;39(5):647‐54. - PubMed

References to other published versions of this review

Chong 2015
    1. Chong LY, Head K, Hopkins C, Philpott C, Burton MJ. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2015, Issue 12. [DOI: 10.1002/14651858.CD011993] - DOI - PMC - PubMed

Publication types