xRead - Nasal Obstruction (September 2024) Full Articles

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302

International consensus statement on rhinosinusitis

worsen ABRS. Systematic reviews have looked at their effi cacy in the treatment of adult ARS. 26,32,88,151,451 No evi dence to support their use in this setting was demon strated. In patients with confirmed AR however, an RCT by Braun et al. demonstrated improvement in patient symp toms scores when loratadine was added to antibiotics for treatment of ARS (Table VII-15). 356 Antihistamines for ARS Aggregate Grade of Evidence: C (Level 2: 1 study; level 5: 4 studies; Table VII-15). Benefit: Relief of AR symptoms associated with ARS. Harm: Some antihistamines may cause sedation (see Table II-1). Cost: Low direct cost. Benefits-Harm Assessment: Preponderance of benefit over harm has not been demonstrated. Value Judgments: None. Policy Level: Option. Intervention: Antihistamines are an option in ABRS with comorbid AR and can be used to decrease symptoms of AR. VII.D.4.c. Mucolytics Although commonly prescribed by practitioners for ARS, evidence for or against the use of mucolytics in this con dition is lacking. 88,451 In an RCT of subacute RS patients, Bahtouee et al. found that adding acetylcysteine 600 MG orally once daily to the treatment regimen did not have any benefit when measured radiographically or via symptom scores (Table VII-16). 213 Mucolytics for ARS Aggregate Grade of Evidence: D (Level 3: 1 study, Level 5: 2 studies; Table VII-16). Benefit: Thinning of mucus theoretically leading to increased MCC. Harm: Costs of medication. Cost: Low direct cost. Benefits-Harm Assessment: Preponderance of benefit over harm has not been demonstrated. Value Judgments: None. Policy Level: No recommendation. Intervention: Based on the current evidence, no recommendation can be given for mucolytics in ABRS.

No significant difference in MCC between the groups.

TABLE VII-13 Evidence for nasal saline treatment in ARS Study Year LOE Study Design Study Groups (n) Device Clinical Endpoint Conclusions Gelardi 437 2009 3 RCT, UB, NPC ABRS 1. Syringe (10) 2. Irrigation bag (10) Syringe 10 mL Irrigation bag 250 mL Nasal obstruction, rhinorrhea, and post-nasal drip (visual analog scale) and anterior rhinomanometry at 3 weeks The irrigation bag group had significantly greater symptoms reduction than syringe group for rhinorrhea and post-nasal drip. No significant difference in nasal obstruction and anterior rhinomanometry between groups. Inanli 417 2002 3 RCT,UB, PC ABRS Syringe 10 mL Change in MCC at 3 weeks

1. Hypertonic saline (12) 2. Isotonic saline (13) 3. No saline (12)