Therapeutic targets in rhinosinusitis: infection or inflammation?

Rhinosinusitis (RS) is an inflammatory condition of the contiguous nasal and paranasal sinuses that is accompanied by a viral or bacterial infection. Controlling the inflammation will attenuate many of the symptoms of RS, including nasal blockage discharge, facial discomfort, headache, and hyposmia, and promote the clearance of the infectious agent.The objective is to review the efficacy of symptomatic treatment with intranasal corticosteroids (INS) for the inflammatory component of acute, recurrent, or chronic RS in adults and children.Published English-language articles identified in the PubMed and MEDLINE databases.Only studies about clinical trials that were randomized, double-blind, and controlled for either placebo or active comparator were selected as valid evidence of the efficacy and tolerability of symptomatic treatment. Studies of INS use as monotherapy or adjunctive therapy with an antibiotic were consulted.Data from clinical studies included size of patient population, efficacy endpoints, systemic and topical adverse events, and criteria for confirming a diagnosis of RS.Data showed that INS improved many of the symptoms of RS, including nasal blockage and purulence, facial discomfort, and headache. Significant improvement compared with placebo was demonstrated in most studies in adults and children with acute RS and in adults with recurrent or chronic RS, whether INS were used as monotherapy or adjunctive treatment. INS were shown to be well tolerated in all of these studies.INS reduce local inflammation and improve drainage, effects that are critical to the resolution of acute RS.