Nasal Corticosteroid Delivery Methods in Chronic Rhinosinusitis With Polyps: A Systematic Review.

Abstract

This systematic review evaluates and compares the efficacy and safety of different intranasal corticosteroid delivery methods for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science were systematically searched from January 1, 1980 to January 9, 2024. Two independent reviewers searched 4 databases for English-language, prospective randomized controlled trials (RCT), comparing different delivery methods of corticosteroids for the treatment of CRSwNP. Studies were excluded for specific reasons (wrong comparisons, wrong intervention, wrong patient population, and wrong route of administration). The data search identified 2282 studies. After removing duplicates, 1503 studies were screened by title and abstract, with 1479 excluded for not meeting criteria. Eighteen full-text articles were assessed for eligibility, and 5 RCTs were included in the review. Both short- and long-term treatments with nebulizer, aerosol spray, and nasal drop methods demonstrated similar efficacy to oral corticosteroids (OCS) but with a better safety profile. Long-term use of aqueous sprays showed clinical improvement but was less effective than other non-aqueous delivery methods. Non-aqueous delivery methods, including nebulizers, aerosol sprays, and nasal drops offer a safe alternative to OCS without systemic side effects. Patients using aqueous formulations should be advised on the importance of long-term adherence to achieve symptom improvement.