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Scant Data on Oral Corticosteroid Therapy for CRS Without Polyps

by James A. Stankiewicz, MD •

How well do our non-polyp chronic rhinosinusitis patients do when treated with oral steroids as part of their medical therapy?

Background: Because we now look at chronic rhinosinusitis (CRS) as an inflammatory problem, the use of topical and oral corticosteroids becomes more important. Systematic evaluation of oral steroid use in CRS without nasal polyposis (CRSsNP) has not been done previously. The objective of this study was to review any evidence in the CRS literature.

Study design: Ovid and PubMed databases searched for studies on oral steroid therapy for CRS with nasal polyps. All manuscripts were graded using evidence-based medicine (EBM) levels.

Setting: Academic medical center.

Synopsis: Out of 2,397 abstracts, 126 showed evidence of oral steroid use in CRS. Further review showed 33 studies, including 30 relating to CRSsNP and three relating to allergic fungal sinusitis (AFS). The CRSsNP studies did not include randomized controlled trials or clinical studies employing oral corticosteroids alone. Most studies with EBM levels of 4 or 5 consisted of review articles or expert opinion and should therefore be seen as data-weak recommendations for using oral steroids for CRSsNP. One level 3 prospective study involved the use of oral corticosteroids with antibiotics and topical steroids. The multi-drug regimen improved symptoms, radiologic findings, short-term relapses, nasal endoscopy and cytokine pattern expression. For AFS, a level 1 randomized controlled study and a level 3 prospective study found the use of oral corticosteroids beneficial in controlling postoperative recurrence with improved endoscopy and CT scan grade levels.

Bottom line: Oral corticosteroids have not been used alone in any study for CRSsNP; therefore, no data are available. Oral corticosteroids used in combination therapy with antibiotics and topical steroids do show improvement in symptoms, short-term relapses, control of AFS and improved endoscopy and radiologic grading levels. Unfortunately, all these studies have an EBM level of 4 or 5 and, as such, are minimally evidence based.

Citation: Lal D, Hwang PH. Oral corticosteroid therapy in chronic rhinosinusitis without polyposis: a systematic review. Int Forum Allergy Rhinol. 2011;1(2):136-143.

—Reviewed by James A. Stankiewicz, MD