Herbal medicines for the treatment of rhinosinusitis: a systematic review

To assess the efficacy of herbal medicines for treating rhinosinusitis.

Five electronic databases, bibliographies of located papers, manufacturers, and experts in the field.

Inclusion of randomized clinical trials (RCT) testing any herbal medicine in rhinosinusitis, as sole or adjunctive treatment. Data were extracted independently by two reviewers following a predetermined protocol.

Ten RCTs, testing six different herbal products against placebo (8 RCTs) or "no additional treatment" (2 RCTs) were included. Four RCTs tested Sinupret as adjunctive treatment for either acute (3 RCTs) or chronic (1 RCT) rhinosinusitis. The quality of these studies varied, but two in acute sinusitis, including the largest and best quality study, and one in chronic sinusitis reported significant positive findings. Three RCTs tested bromelain in either acute sinusitis (2 RCTs) or patients of mixed diagnosis (chronic and acute sinusitis), and all reported some positive findings. Metanalysis of the two RCTs in acute sinusitis suggested that adjunctive use of bromelain significantly improves some symptoms of acute rhinosinusitis. Single RCTs were identified for 4 other herbal products (Esberitox, Myrtol, Cineole, and Bi Yuan Shu) as treatments for sinusitis, all reported some positive results. The median methodological quality score was 3 of 5.

Evidence that any herbal medicines are beneficial in the treatment of rhinosinusitis is limited, particularly in chronic rhinosinusitis. There is encouraging evidence that Sinupret and bromelain may be effective adjunctive treatments in acute rhinosinusitis. Positive results from isolated RCTs of four other herbal products require independent replication.