Wu Arthur W, Gettelfinger John D, Ting Jonathan Y, Mort Claudia, Higgins Thomas S
Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN.
Int Forum Allergy Rhinol. 2020 Apr;10(4):496-504. doi: 10.1002/alr.22488. Epub 2020 Feb 27.
Sinusitis and rhinitis are common diseases for which patients seek medical attention. Alternative therapies constitute a multibillion-dollar industry despite poorly established efficacy and safety profiles. This study was designed to identify and grade the evidence for alternative therapies purported to treat sinusitis and rhinitis.
A modified Delphi method was used to establish a consensus opinion among rhinology experts of the current evidence for efficacy, potential harm, and future research needs for alternative therapies in sinusitis and rhinitis. Following the initial Delphi round of discussion, a Google search query was performed to identify topics and review online reports of benefit. Subsequent rounds established search criteria and inclusion/exclusion criteria for a systematic literature review utilizing PubMed, EMBASE, and Cochrane databases. Centre for Evidence-Based Medicine (CEBM) and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess levels of evidence and recommendations. Final Delphi rounds were performed until consensus opinions could be reached.
Over 60 potential alternative therapies for sinusitis and rhinitis were identified. The literature review included 2066 titles with 220 full-text articles found to be relevant. Most of the therapies had little to no scientific evidence; however, acupuncture, capsaicin, bromelain, and butterbur extract currently have low to moderate-high GRADE rating. Allergic rhinitis was the most common disease studied.
Some alternative therapies show promise as potential treatments for sinusitis and rhinitis, mostly compared to placebo. Comparisons to traditional therapies are lacking. For other alternative therapies, many websites included unsubstantiated claims of benefit and ignored potential side effects for which patients should be warned appropriately.
鼻窦炎和鼻炎是患者寻求医疗关注的常见疾病。尽管替代疗法的疗效和安全性尚未得到充分证实，但该行业规模已达数十亿美元。本研究旨在识别并分级那些声称可治疗鼻窦炎和鼻炎的替代疗法的证据。
采用改良的德尔菲法，就替代疗法治疗鼻窦炎和鼻炎的疗效、潜在危害及未来研究需求的现有证据，在鼻科学专家中达成共识意见。在第一轮德尔菲讨论之后，进行了谷歌搜索查询，以确定相关主题并查阅有关疗效的在线报告。随后几轮确定了利用PubMed、EMBASE和Cochrane数据库进行系统文献综述的搜索标准和纳入/排除标准。使用循证医学中心（CEBM）和推荐分级、评估、制定与评价（GRADE）标准来评估证据水平和推荐等级。进行最后几轮德尔菲法，直至达成共识意见。
共识别出60多种治疗鼻窦炎和鼻炎的潜在替代疗法。文献综述纳入了2066个标题，其中220篇全文文章被认为相关。大多数疗法几乎没有科学证据；然而，针灸、辣椒素、菠萝蛋白酶和提取物目前的GRADE评级为低至中高等级。变应性鼻炎是研究最多的常见疾病。
一些替代疗法有望成为治疗鼻窦炎和鼻炎的潜在方法，大多是与安慰剂相比。缺乏与传统疗法的比较。对于其他替代疗法，许多网站所载的疗效声称未经证实，且忽视了潜在的副作用，应适当警告患者。
