xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

VII.D.4.d. Herbal Remedies A number of herbal interventions for ARS have been published in the literature 452–454 with some systematic reviews showing some promise of benefit without suffi cient evidence for recommendations. 26,455–457 InaDBPCT of acute upper respiratory tract infection by Gabrielian et al., 452 patients were treated with Andrographis panicu lata/Eleutherococcus senticosus herbal for 5 days. Patients treated with the herbal had greater improvement in mean symptom scores at the end of treatment including in the subset of patients with ARS. Bachert et al. found that Pelargonium sidoides extract provided superior improve ment of sinonasal symptoms compared to placebo after 7 days of treatment. 453 Although extract of Pelargonium sidoides and cineole have evidence suggesting efficacy, methodological flaws and possible conflicts of interests in their associated stud ies makes it difficult to make any useful recommendations regarding their use other than the need for further well designed trials (Table VII-17). 453,458,459 Herbal Remedies for ARS Aggregate Grade of Evidence: B (Level 1: 3 studies; level 3: 5 studies; level 5: 1 study; Table VII-17). Benefit: Symptom improvement. Harm: Side effects depending on herbal remedy ingredients. Cost: Low direct cost. Benefits-Harm Assessment: Preponderance of benefit over harm has not been demonstrated. Value Judgments: Lack of conclusive evidence to recommend herbal remedies. Policy Level: No recommendation. Intervention: None. Side effects should be consid ered if used. * AGE combines data from various individual herbal therapies. There is insufficient evidence to recommend treatment with individual herbal therapies for ARS at this time.

Rosenfeld 88 2015 5 Guideline No evidence to support use of mucolytics in ABRS

TABLE VII-16 Evidence for mucolytics in ARS treatment Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Bahtouee 213 2017 3 DBRCT Subacute rhinosinusitis patients Sinus CT changes Lund-Mackay score SNOT-20 score No benefit to adding acetycysteine

Peters 451 2014 5 Guideline No evidence for use or lack of sufficient

prospective studies of mucolytics in ABRS

treated with amoxicillin/clavulanic acid, saline and oral pseudoephedrine and: Acetylcysteine Placebo

VII.E Complications of ARS While a variety of complications can arise from ARS, 460,461 overall these are rare. Only about 1 in 95,000 hospi tal admissions in the United States is due to complica tions from ARS. 32 These are broadly subdivided as orbital, intracranial, and osseous complications.