xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

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Strong recommendation: For short-term management of

CRSwNP. Longer term use of is not supported by the literature and carries increased risk of harm

Option: Standard metered dose INCS could be used in treatment of CRSsNP, particularly if primary

symptoms are that of rhinitis

Strong Recommendation: INCS are recommended for

CRSwNP before or after sinus surgery. Consideration for

twice daily dosing if initial treatment effect is small

irrigation improves symptoms, QoL and nasal endoscopy.

Duration of should be greater than 8 weeks. Hypertonic

saline is more effective but

may be more irritating than isotonic saline. There is no

advantage of heated over room temperature saline. Devices

with volume greater than 60 mL bring greater benefits

Recommendation: Saline

Benefit-Harm Assessment Policy Level

Possible mild benefit overharm

Benefit outweighs harm

benefit over harm with short-term

treatment with follow-up

benefit over harm

Low Preponderance of

Low Preponderance of

Moderate

Moderate

Lowto

Lowto

TABLE I-4 Grade A/B evidence-based recommendations for medical management of CRS Intervention Grade Benefit Harm Cost CRSsNP: Saline Irrigation, Drops, Sprays B Improvement in QoL, endoscopic appearance, and role in maintenance therapy. Benefit over control was shown with saline irrigations ( ≥ 60mL) and at 8 weeks duration Minor and rare adverse effects. Nasal burning and irritation are more reported with hypertonic irrigation; See Table II-1. CRSwNP: Oral Corticosteroids A Significant short-term improvements in subjective and GI symptoms, transient adrenal suppression,

Epistaxis, nasal irritation, headache; See Table II-1.

insomnia, and increased bone turnover. All established systemic corticosteroid risks

exist, particularly with prolonged treatment; See Table II-1.

Epistaxis, nasal irritation, headache; See Table II-1.

A Improved symptom scores, improved

endoscopy scores.

objective measures. Duration may last 8-12 weeks in

conjunction with topical INCS

A Improved symptoms, endoscopy score, polyp size, QoL,

olfaction, airway

analysis (NPIF), and polyp recurrence.

Magnitude of the clinical effect is small

CRSsNP: Intranasal Corticosteroid Spray

CRSwNP: Intranasal Corticosteroid Spray