Home Forums Other Specialities ENT CHRONIC SINUSITIS in ADULTS: THERAPIES.

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      Anonymous
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      Medical Therapies for Adult Chronic Sinusitis
      A Systematic Review
      JAMA. 2015;314(9) September 1st.

      Importance

      Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months.
      It accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures. Appropriate use of medical therapies for chronic sinusitis is necessary to optimize patient quality of life (QOL) and daily functioning and minimize the risk of acute inflammatory exacerbations.

      Objective
      To summarize the highest-quality evidence on medical therapies for adult chronic sinusitis and provide an evidence-based approach to assist in optimizing patient care.

      Evidence Review A systematic review searched Ovid MEDLINE (1947-January 30, 2015), EMBASE, and Cochrane Databases. The search was limited to randomized clinical trials (RCTs), systematic reviews, and meta-analyses. Evidence was categorized into maintenance and intermittent or rescue therapies and reported based on the presence or absence of nasal polyps.

      Findings
      Twenty-nine studies met inclusion criteria: 12 meta-analyses (>60 RCTs), 13 systematic reviews, and 4 RCTs that were not included in any of the meta-analyses.

      Saline irrigation improved symptom scores compared with no treatment (standardized mean difference [SMD], 1.42 [95% CI, 1.01 to 1.84]; a positive SMD indicates improvement).
      Topical corticosteroid therapy improved overall symptom scores (SMD, ?0.46 [95% CI, ?0.65 to ?0.27]; a negative SMD indicates improvement), improved polyp scores (SMD, ?0.73 [95% CI, ?1.0 to ?0.46]; a negative SMD indicates improvement), and reduced polyp recurrence after surgery (relative risk, 0.59 [95% CI, 0.45 to 0.79]).

      Systemic corticosteroids and oral doxycycline (both for 3 weeks) reduced polyp size compared with placebo for 3 months after treatment (P?

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