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Review
. 2025 Jul 10;17(7):e87674.
doi: 10.7759/cureus.87674. eCollection 2025 Jul.

The Efficacy and Safety of Intranasal Corticosteroids in Chronic Rhinosinusitis: A Systematic Review

Abdualllah A Mawkili  1 , Jarallah H Alghazi  2 , Abdullah M Alqahtani  3 , Mohammed A Alshalwan  4 , Shahd Alallah M Essa  5 , Ghadah I Alissa  6 , Abdulrazaq I Althobaiti  7 , Rakan Y Alsuwayyid  8 , Saeed E Alzahrani  9 , Saud T Alaidarous  9 , Ahmed Y Ayoub  5
Affiliations
Review

The Efficacy and Safety of Intranasal Corticosteroids in Chronic Rhinosinusitis: A Systematic Review

Abdualllah A Mawkili et al. Cureus. .

Abstract

Chronic rhinosinusitis (CRS), with or without nasal polyps (CRSwNP/CRSsNP), is a prevalent inflammatory condition of the sinonasal mucosa, for which intranasal corticosteroids (INCS) are widely used as first-line therapy. This systematic review evaluated the efficacy and safety of INCS, used alone or with adjunctive treatments, in improving clinical outcomes in CRS patients. A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, Web of Science, and the Virtual Health Library (VHL) through May 2025, including randomized controlled trials (RCTs) assessing INCS efficacy in adults and children with CRS. Outcomes examined included nasal polyp score (NPS), nasal congestion, quality of life (QoL), sinus opacification, olfactory function, acute exacerbations, and adverse events. Six high-quality RCTs involving 2,339 participants were included. Dupilumab demonstrated the greatest NPS reduction (Δ-2.06), improved nasal congestion, and reduced the need for surgery or systemic steroids. Mepolizumab, omalizumab, and benralizumab were also effective in reducing polyp size and symptoms, particularly in eosinophilic CRS. EDS-FLU (exhalation delivery system with fluticasone) improved congestion, SNOT-22 (22-item Sino-Nasal Outcome Test) scores, and reduced acute exacerbations. In pediatric patients, mometasone delivered with saline nebulization significantly improved SN-5 scores. All interventions were well tolerated, with few adverse events reported. Overall, INCS are effective in managing CRS symptoms and reducing disease burden, particularly when combined with biologics or advanced delivery systems, and remain a cornerstone of CRS management with a strong safety and efficacy profile across diverse populations.

Keywords: biologics; chronic rhinosinusitis; crssnp; crswnp; dupilumab; exhalation delivery system; fluticasone; intranasal corticosteroids; mepolizumab; nasal polyps.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram illustrating the study selection process for the systematic review on intranasal corticosteroids in chronic rhinosinusitis
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

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