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Topical treatment of rhinosinusitis

A Fiocchi1, T Sarratud, G R Bouygue

  • 1Melloni Paediatria and the Fatebenefratelli Hospital, Melloni, Milan, Italy. allerg@tin.it

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|December 6, 2007
PubMed

Insights

Evidence for topical treatments in pediatric rhinosinusitis is limited, with only topical steroids showing clear efficacy. Most widely used treatments lack robust clinical trial support for effectiveness in children.

Area of Science:

  • Pediatric Otolaryngology
  • Clinical Evidence Review
  • Pharmacology

Background:

  • Topical treatments are widely used for pediatric rhinosinusitis.
  • Current clinical evidence supporting their efficacy is often limited or methodologically flawed.

Purpose of the Study:

  • To review and assess the current clinical evidence for the efficacy of various topical treatments used in pediatric rhinosinusitis.
  • To identify treatments with robust evidence supporting their use in children.

Main Methods:

  • Systematic literature search of PubMed using specific keywords and filters (clinical trials, pediatric population, last 10 years).
  • Inclusion of comparator agents: steroids, irrigation, saline, antihistamine, decongestant, antibiotic, antimycotic, fungicide.
  • Inclusion of authors' clinical experience from a pediatric allergy unit.

Main Results:

  • Only one retrieved pediatric study met current evidence-based medicine standards for clinical trials.
  • Studies exhibited significant methodological, analytical, and interpretation biases, preventing systematization.
  • Topical steroids demonstrated the most consistent evidence of efficacy, unlike other widely used treatments.

Conclusions:

  • Evidence for the efficacy of most topical treatments in pediatric rhinosinusitis is narrative and lacks robust support.
  • While not definitively excluded from treatment protocols, most topical therapies lack weighable evidence of effectiveness beyond subjective appraisal.
  • Topical steroids represent an exception, with some evidence supporting their use in pediatric rhinosinusitis management.

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