Oral corticosteroid therapy in chronic rhinosinusitis without polyposis: A systematic review

Background: Recognition of inflammation in the pathophysiology of chronic rhinosinusitis (CRS) has caused corticosteroid therapy in CRS to gain favor. A systematic evaluation of oral steroid use in CRS without nasal polyps (CRSsNP) has not been previously conducted. The objective of the study was to assess evidence on oral steroid therapy in CRSsNP, via a systematic literature review. Methods: Ovid and PubMed databases were searched for studies on oral steroid therapy in CRSsNP. Manuscripts were reviewed and graded by evidence-based medicine (EBM) level. Results: A total of 33 studies met inclusion criteria; 30 on CRSsNP and 3 on allergic fungal sinusitis (AFS). CRSsNP studies did not include any randomized controlled trial (RCT) or any clinical study employing systemic corticosteroids alone. They included 20 reviews/expert opinions (Level 5) with differing recommendations, and 4 treatment guidelines (Level 4) with weak recommendations on use. Three studies, 2 retrospective (Level 4) and 1 prospective study (Level 3), used oral steroids in combination with antibiotics and nasal steroids. The multidrug regimen improved symptoms, radiologic findings, short-term relapses, nasal endoscopy, and cytokine pattern expression. An experimental study (Level 5) found oral steroids to reverse sinonasal tissue inflammation. Two studies in animal models (Level 5) found no benefit of adding systemic steroids to antibiotics. Three clinical AFS studies, 1 RCT (Level 1) and 2 prospective (Level 3), found oral steroids to benefit postoperative recurrence, endoscopy or computed tomography (CT). Conclusion: No study has employed systemic corticosteroids alone in treating CRSsNP. Evidence supporting oral steroid therapy in CRSsNP is mostly Level 4 or 5; there is lack of any RCT to support use.