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Literature Review: A Roundup of Important Recent Studies

Wide Variation in Maximal Medical Therapy for CRS

What is maximal medical therapy for chronic rhinosinusitis?

Background: Even 27 years after the introduction of endoscopic diagnosis and treatment of chronic rhinosinusitis (CRS), “maximal medical therapy” has not been defined. In its clinical indicators, the American Academy of Otolaryngology-Head and Neck Surgery recommends three weeks of an antibiotic with a topical steroid. A recent survey from the American Rhinologic Society indicated that the majority of respondents also used an oral steroid, achieving good results in CRS with polyposis, allergic fungal sinusitis and CRS without polyposis. This current study was designed to shed some light on the topic.

Study design: A survey of 603 otolaryngology consultants in the UK to assess prescription, duration and type of medical therapy for CRS.

Setting: Private and academic practice.

Synopsis: Out of the 603 surveyed, 158 returned questionnaires. Sixty-one percent of the respondents were rhinologists. The results indicated that decongestants, antifungals and immunotherapy were used in a very limited fashion for treatment. Clarithromycin for five weeks or less was the preferred antibiotic choice. Sixty percent of the respondents always prescribed a topical steroid. Oral steroids were used sparingly.

Bottom line: There are few evidence-based studies helping to define maximal medical therapy for CRS. These studies indicate that if antibiotics, topical steroids and decongestant are used for treatment, 50 percent resolve CRS. If oral corticosteroids are added, 75 percent will resolve CRS. This survey on preferences indicates that most respondents use oral antibiotics, steroid nasal sprays and saline douches. Almost predictably, however, “maximal medical” therapy for CRS varies greatly among participants and does not reflect recent evidence or guidelines.

Reference: Sylvester DC, Carr S, Nix P. Maximal medical therapy for chronic rhinosinusitis: a survey of otolaryngology consultants in the United Kingdom. Int Forum Allergy Rhinol. 2013;3:129-132.

—Reviewed by James A. Stankiewicz, MD

“Sinus Headache” Diagnosis and Treatment

How can you distinguish between a true rhinological headache and a migraine headache?

Background: Otolaryngologists see patients who complain of “sinus headaches.” The media has accepted the term. However, literature reviews and practitioner experience agree it is an overused phrase that is often incorrect. While review articles and consensus panels have discussed “sinus headache,” there are currently no evidence-based guidelines available for diagnosis and treatment.