Department of Otolaryngology-Head and Neck Surgery, 12275Washington University School of Medicine in St. Louis, MO, USA.
158158Meharry Medical College, Nashville, TN, USA.
Ear Nose Throat J. 2021 Jun;100(5):329-334. doi: 10.1177/0145561321998521. Epub 2021 Mar 8.
Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS.
A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed.
Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies.
Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.
慢性鼻-鼻窦炎（CRS）是一种鼻窦和黏膜的炎症性疾病。局部鼻腔皮质类固醇通过减少鼻-鼻窦炎症和改善黏液纤毛清除来治疗 CRS，是一种主要的治疗方法。然而，局部皮质类固醇在副鼻窦中的分布有限，并且在随机对照试验（RCT）中，患者对治疗的反应存在差异。因此，人们非常关注评估通过鼻腔冲洗给予鼻腔类固醇的疗效，以提高局部类固醇向鼻-鼻窦黏膜的穿透和吸收。在这篇综述中，我们讨论了在 CRS 管理中使用未经批准的鼻腔类固醇冲洗的问题。
对 PubMed 电子数据库中评估鼻腔类固醇冲洗治疗 CRS 的临床试验进行了回顾。
在确定的 12 项临床研究中，有 10 项评估了布地奈德冲洗液，其余 2 项研究则集中于糠酸莫米松。布地奈德和糠酸莫米松的绝大多数研究都支持在鼻腔皮质类固醇喷雾的基础上使用皮质类固醇鼻腔冲洗，而不是单纯使用鼻腔皮质类固醇喷雾。然而，这些研究的设计、患者队列和类固醇冲洗量存在差异，限制了对这些研究的解释。
鼻腔冲洗加皮质类固醇治疗 CRS 是有益和安全的。未来需要进行 RCT，以控制手术干预的类型、CRS 表型和内型，以及鼻腔皮质类固醇冲洗的剂量和时间。
