question and answer
June 2012
Could you please discuss the role of inhaled nasal steroids in the treatment of acute sinusitis with/without a prior history of allergic rhinitis?
David Newman, MD, Surrey, BC

Inhaled glucocorticoids have improved the management of upper and lower airway inflammatory conditions by reducing eosinophil activity and secretion of cytokines, thereby resulting in an overall anti-inflammatory effect. These effects should be expected in both allergic and non-allergic rhinosinusitis.

The indications for corticosteroids in rhinosinusitis are: acute rhinosinusitis, prophylactic treatment of recurrent acute rhinosinusitis, and chronic rhinosinusitis with or without nasal polyposis.

In the case of acute rhinosinusitis, nasal steroids have been proven to be effective twice daily as monotherapy and as an adjunct therapy to antibiotics. The 2007 European Position Paper on Rhinosinusitis and Nasal Polyps recommends that symptoms of a viral upper respiratory tract infection lasting < 5 days should be adequately managed with symptomatic relief, while symptoms persisting or worsening after > 5 days merit the addition of topical nasal steroids. Should there be no effect in 48 hours or complicated underlying comorbidities, systemic antibiotics could then be added.

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