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ARE NASA STEROID SPRAYS
BENEFICIAL IN ACUTE SINUSITIS?
Although some clinicians prescribe intranasal corticosteroids for patients with acute sinusitis, evidence that supports this practice is limited. In this multicenter study, researchers treated 407 patients who had acute sinusitis with a 3-week course of amoxicillin/clavulanate; the patients were randomized to receive, as adjunctive therapy, either mometasone furoate nasal spray or placebo spray. Each patient had a previous history of recurrent sinusitis, a current acute episode, and a CT scan showing mucosal thickening, opacification, or air/fluid levels. The study was supported by the maker of the nasal steroid.
Before treatment, patients had a mean score of 11 on an 18-point scale that rated 6 symptoms (congestion, headache, facial pain, cough, rhinorrhea, and post-nasal drip). During the 3-week treatment, the average scores drops by about 5 points with placebo and by about 6 points with nasal steroid-a significant difference that became evident after about 1 week. There were no adverse effects from the steroid spray.
Comment: These findings suggest that intranasal steroids offer a modest benefit when added to antibiotic therapy for acute sinusitis. Whether that benefit is worth the additional cost obviously will vary from patient to patient. Moreover, it may be difficult to extrapolate these findings to general practice, because clinicians differ considerably in their thresholds for diagnosing acute sinusitis.
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