xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Orlandi et al.

No difference at 12 weeks post ESS. Xu 1540 2019 2 RCT Oral corticosteroid + INCS Symptoms (VAS)

No difference in symptoms between arms or between

subtypes (CRSsNP, CRSwNP (Eos and non-Eos).

endoscopic inflammation at 6 months.

Polyp score 3 RCTs with twice daily INCS improved NP score. Polyp score

2 RCTs with once daily INCS with no change in NP score.

Symptoms and NP score favor INCS.

The quality of the evidence was moderate for nasal blockage, rhinorrhea and smell

disturbance, but low for facial pain/pressure. Increased risk of epistaxis.

Corticosteroid drops and oral were similar. All better than INCS alone.

Dose, Duration, Delivery Method Clinical Endpoint Conclusions PROMs Adverse events

1, 3, 6, and 12 months postop. Non-Eos CRSwNP had less

Khan 1542 2019 2 RCT INCSdaily Both better than placebo. Twice daily better than once daily. Seiberling 1541 2019 2 RCT INCS high dose (n = 8) INCS standard (n = 10) Dexamethasone 0.032% fluticasone propionate 12weeks SNOT22 Endoscopic Score INCS twice daily Placebo (n = 310) Mometasone 200 μ g/dose 4months Nasal congestion

Symptoms (VAS)

Endoscopic score

NP score (16 weeks)

Symptoms (4 weeks)

Endoscopic score

Serum Eosinophil

Budesonide drop (1 mg/d) + budesonide spray Budesonide spray 256 μ g/d) All 1week Fluticasone 200 μ gdaily

Zhou 1543 2016 2 RCT INCS twice daily (n375) Placebo (n = 373) Mometasone 200 μ g twice daily (400 μ g) 16weeks

Methylprednisolone (24 mg/d) for 1week + budesonide spray

Twice daily and Once daily INCS

RCTs (n = 18) RCTs of CRSwNP (n = 14) Analysis including dose, frequency and agent

Clarithyromicin 250 mg Daily For 3 months

Type of Corticosteroid,

Macrolide (n = 187)

Zeng 1539 2019 2 RCT INCS (n = 187)

(n = 1712)

Corticosteroid drop and INCS INCSalone

6RCTs

Post ESS for 3 months

Schenkel 1544 2019 1 Meta-analysis of RCT

Chong 1545 2016 1 Systematic review ofRCTs

TABLE X-18 Evidence for CRSwNP management with topical corticosteroids (standard delivery with sprays and drops) Study Year LOE Study Design Study Groups