xRead - Nasal Obstruction (September 2024) Full Articles

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TABLE IX-27 Evidence for CRSsNP management with topical nasal corticosteroids (nonstandard delivery) Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Grayson 1089 2019 1 Systematic Review Steroid irrigation Steroid spray Placebo SNOT-22 Endoscopy score Best outcomes with large volume, low pressure devices. Harvey 1077 2018 (n = 44) 2 DBRCT 12 month follow up; mometasone irrigation vs spray (both 2 mg) post-ESS VAS SNOT-22 Radiographic LM scores Improved nasal blockage and LM score with fewer recurrences with irrigation. Tait 1078 2018 (n = 61) 2 DBRCT 30 day course of budesonide vs saline irrigations SNOT-22 Clinical Global Impressions Endoscopy score Improved SNOT-22 scores in budesonide group, particularly among CRSsNP, results not significant. Thamboo 1086 2014 (n = 20) 2 RCT - unblinded 1 mg budesonide via mucosal atomization device 1 mg budesonide in 120 mL saline via large volume irrigation SNOT-22 ACTH stimulation test Plasma cortisol levels MAD-delivered budesonide improved SNOT-22. A slight reduction in ACTH stimulated cortisol levels was seen. Hansen 1071 2010 (n = 20) 2 DBRCT Bi-directional spray 12 week course of: - Fluticasone propionate 400 μ gBID - Placebo RSOM-31 Subjective symptoms Nasal endoscopy Peak nasal flow Acoustic rhinometry MRI sinuses Fluticasone improved nasal symptom scores, endoscopic nasal edema, and peak nasal airflow. Furukido 1069 2005 (n = 25) 2 RCT – single blinded 1 month course of once weekly irrigations via YAMIK sinus catheter - Saline solution -Betamethasone (0.4 mg/mL) solution Clinical symptom score Radiologic (Sinus x-ray score) Sinus effusion cytokine levels No difference between study groups’ clinical or radiological scores. Lavigne 1066 2002 (n = 13) 2 DBRCT Unilateral MAST catheter with 3 week daily irrigation with either: - 256 μ g budesonide - Placebo Nonvalidated clinical response score Tissue eosinophil counts Tissue IL-4 and IL-5 levels Treatment improved clinical response scores and reduced eosinophil counts and IL-4/5 levels.