Which treatments are safe and effective for chronic sinusitis?
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Q: Which treatments are safe and effective for chronic sinusitis? Evidence-based answer: for adults with chronic rhinosinusitis (crs), intranasal steroid (ins) therapy is more likely than placebo to improve symptoms (50% vs 32%; strength of recommendation [SOR]: A, systematic reviews). Nasal saline irrigation (SI) alleviates symptoms better than no therapy (SOR: A, systematic reviews), but it's probably not as effective as INS treatment (SOR: B, randomized controlled trial [RCT] with wide confidence interval). Long-term (12 weeks) macrolide therapy doesn't alter patient-oriented quality-of-life measures (SOR: A, systematic reviews). Endoscopic sinus surgery improves CRS symptoms -- nasal obstruction, discharge, and facial pain -- over baseline (SOR: A, systematic reviews). Surgery and medical therapy appear about equivalent in terms of symptom improvement and quality-of-life measures (SOR: B, systematic reviews of low-quality RCTs).
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