Release Date:April 17, 2007, 7:01 PM US Eastern time

Steroid Nasal Sprays Relieve Sinusitis Symptoms, Review Finds
By Amy Sutton, Contributing Writer
Health Behavior News Service

Every year, nearly 37 million Americans suffer from the sinus pressure,
nasal congestion, cough and postnasal drip that accompany sinusitis.

Doctors often prescribe antibiotics to relieve acute sinusitis, which
can develop following a chest cold. However, steroid nasal sprays —
either alone or with antibiotic therapy — may better ease symptoms and
speed recovery, suggests a new review by Israeli researchers.

Sinusitis is an inflammation of the mucous membranes that line the sinus
cavities. Steroid sprays like Flonase, Nasonex and Rhinocort, which work
by reducing inflammation to promote drainage in the sinuses, are often
prescribed to treat chronic sinusitis and allergies symptoms.

But the use of steroids sprays for acute sinusitis is not as universally
accepted.

In this review, Anca Zalmanovici, a family physician at Rabin Medical
Center in Petach Tikva, and her co-author analyzed data from four
randomized controlled trials including nearly 2,000 participants, all
with clinical symptoms of acute sinusitis.

The review appears in the current issue of The Cochrane Library, a
publication of The Cochrane Collaboration, an international organization
that evaluates research in all aspects of health care. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing trials on a topic.

Two of the studies evaluated patients at treatment centers in the United
States, one took place in Turkey and the other included 71 medical
centers in 14 countries.

Study participants, who underwent X-rays or nasal endoscopy to confirm
diagnosis, received either a placebo or intranasal corticosteroids for
two or three weeks, alone or in combination with antibiotics. Intranasal
corticosteroids used included fluticasone propionate (Flonase),
mometasone furoate (Nasonex) and budesonide (Rhinocort).

Overall, 73 percent of the patients treated with nasal steroids
experienced relief or marked improvement of symptoms during the study
period, compared with only 66.4 percent of patients who received the
placebo.

“For every 100 patients treated with intranasal corticosteroids, seven
additional patients had complete or marked symptom relief,” compared to
those in the placebo group, the reviewers found.

Researchers pooled results from three of the four studies, excluding the
lowest-quality study from the statistical analysis.

None of the studies reported serious side effects, and rates of
sinusitis relapse were similar between the treatment and placebo groups.

Stronger doses of nasal steroids appeared to work better. Patients
receiving daily doses of 400 micrograms were more likely to experience
relief of sinusitis symptoms, than were patients receiving 200-microgram
doses.

Although there is not enough evidence to suggest that nasal steroids can
stand alone for acute sinusitis treatment, “the results of these studies
and reviews support the current clinical rationale of adding an
intranasal corticosteroid to antibiotic therapy,” reviewers say.

Allen Seiden, M.D., director of the University of Cincinnati Taste and
Smell Center, said that more data are required before routine
recommendations on intranasal corticosteroids can be made.

“It seems to have been a well-conducted review, with thorough
statistical analysis. However, in the end, it analyzed relatively few
studies,” Seiden said.

He added that the review lacked information about how individual
diagnoses were made, and said that even with X-rays and nasal endoscopy,
distinguishing between viral and bacterial infections can be difficult,
a problem that may influence the choice of treatment.

When it comes to treating sinus infections, “patients vary as to when
they will seek medical intervention. Some will come in after only a day
or two of symptoms; some not for two to three weeks,” Seiden said.
Longer waits can make symptoms harder to treat, he said, “while many
patients with symptoms for only a few days will in fact have a viral
infection.”

Although there are few downsides to using nasal steroids such as those
in the review —they are fairly expensive, Seiden said. According to the
National Institute of Allergy and Infectious Diseases, diagnosing and
treating sinusitis costs Americans nearly $6 billion every year.

http://www.hbns.org/getDocument.cfm?documentID=1482