1 Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
2 Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Horizon Health Network, Saint John, New Brunswick, Canada.
Am J Rhinol Allergy. 2019 Mar;33(2):194-202. doi: 10.1177/1945892418813079. Epub 2018 Nov 28.
Complementary and alternative medicine (CAM) is frequently used in the treatment of chronic rhinosinusitis (CRS) in developed countries. With a plethora of CAM therapies available, their effectiveness and safety are poorly understood in the context of CRS.
This article aims to critically appraise the evidence for CAM use in CRS through a systematic review of current literature that investigate the effects of CAM on symptoms and clinical status of adults with CRS.
Systematic review and qualitative analysis.
A comprehensive systematic review of the literature was conducted by the authors using 5 databases from inception to July 2017: CINAHL, Cochrane, Embase, PubMed, and SCOPUS. Inclusive medical subject headings and keywords consisted of, but were not limited to, sinusitis and complementary therapies, naturopathy, or traditional Chinese medicine. PRISMA guideline was followed. Using templates by Cochrane Public Health Group and Newcastle-Ottawa Scale, each author extracted data, assessed bias, and computed minimal clinically important difference. Any conflicts were resolved through discussion.
In total, 7 of 7141 articles from 1995 to 2016 were included. Three randomized controlled trials and 4 observational studies were organized into 4 categories of CAM: naturopathy, Chinese medicine, homeopathy, and others. Limited evidence supported the use of Pimpinella anisum and crenotherapy for CRS. Data available on Chinese medicine, homeopathy, and liposomal therapy in CRS were inconclusive due to inherent flaws in the studies.
Overall, there is very limited evidence to support the use of CAM in the treatment of CRS. No significant adverse effects have been found. Given its widespread use, more rigorous data from high-quality research are needed before it can be routinely recommended.
在发达国家，补充和替代医学（CAM）经常用于治疗慢性鼻-鼻窦炎（CRS）。由于有大量的 CAM 疗法可供选择，因此在 CRS 背景下，其疗效和安全性了解甚少。
通过对当前研究的系统评价，批判性地评估 CAM 在 CRS 中的应用证据，这些研究调查了 CAM 对成人 CRS 症状和临床状况的影响。
系统评价和定性分析。
作者使用从开始到 2017 年 7 月的 5 个数据库（CINAHL、Cochrane、Embase、PubMed 和 SCOPUS）进行了全面的系统文献回顾。包括但不限于鼻窦炎和补充疗法、顺势疗法或中药的医学主题词和关键词。遵循 PRISMA 指南。使用 Cochrane 公共卫生组和纽卡斯尔-渥太华量表模板，每位作者提取数据、评估偏倚并计算最小临床重要差异。任何冲突都通过讨论解决。
从 1995 年到 2016 年，共 7141 篇文章中有 7 篇符合纳入标准。3 项随机对照试验和 4 项观察性研究被分为 4 类 CAM：顺势疗法、中药、顺势疗法和其他。有限的证据支持 Pimpinella anisum 和泥疗治疗 CRS。由于研究中存在固有缺陷，关于 CRS 中中药、顺势疗法和脂质体治疗的数据尚无定论。
总体而言，支持 CAM 治疗 CRS 的证据非常有限。尚未发现明显的不良影响。鉴于其广泛应用，需要来自高质量研究的更严格数据，然后才能常规推荐。
