Endoscopic Sinus and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
Int Forum Allergy Rhinol. 2013 Apr;3(4):281-98. doi: 10.1002/alr.21096. Epub 2012 Oct 8.
Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS.
A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review.
This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations).
Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).
局部治疗已成为慢性鼻-鼻窦炎（CRS）管理方案的一个组成部分。已经评估了几种局部治疗策略，但从未进行过正式的综合证据评估。本文旨在提供一种基于证据的方法，用于在 CRS 的管理中使用局部治疗。
对文献进行了系统回顾，并遵循了制定基于证据的综述和建议的指南。研究纳入标准为：成人人群>18 岁；根据已发表的诊断标准诊断为慢性鼻-鼻窦炎（CRS）；以及明确界定的主要临床终点。我们专注于报告更高质量的研究（2b 级或更高），但如果该主题证据不足，则报告较低水平的研究。我们将药物洗脱 spacer 和支架治疗排除在本综述之外。
本综述确定并评估了 5 种 CRS 局部治疗策略的文献：盐水冲洗、局部皮质类固醇、局部抗生素、局部抗真菌和局部替代物（表面活性剂、麦卢卡蜂蜜和木糖醇冲洗液）。
根据现有证据，鼻-鼻窦生理盐水冲洗和标准局部鼻皮质类固醇治疗被推荐用于 CRS 的局部治疗。非标准（超适应证）局部鼻皮质类固醇治疗可能是治疗 CRS 的一种选择。证据不推荐在常规 CRS 情况下使用局部抗真菌治疗和使用雾化和喷雾技术给予的局部抗生素治疗。替代疗法或使用其他给药方法（例如冲洗）给予的局部抗生素治疗的临床研究不足，无法提供建议。
