Update on Intranasal Medications in Rhinosinusitis

Area of Science:

• Otolaryngology
• Pharmacology
• Respiratory Medicine

Background:

• Rhinosinusitis encompasses diverse subtypes affecting adults and pediatrics.
• Intranasal medications are frequently employed for rhinosinusitis management.
• Understanding the efficacy and safety of these treatments is crucial.

Purpose of the Study:

• To review the beneficial effects and adverse events of intranasal medications for rhinosinusitis.
• To evaluate the evidence for various intranasal agents and delivery methods.
• To assess the impact of devices and patient positioning on drug delivery.

Main Methods:

• Systematic review of existing literature on intranasal treatments for rhinosinusitis.
• Analysis of studies reporting on intranasal steroids, saline irrigation, antifungals, and antibiotics.
• Evaluation of factors influencing nasal and paranasal sinus drug delivery.

Main Results:

• Intranasal steroids show benefits across adult rhinosinusitis subtypes; pediatric data is limited but suggests benefits in acute cases.
• Saline irrigation is effective for chronic rhinosinusitis without polyps and pediatric acute rhinosinusitis; evidence for saline drips/sprays is lacking.
• Intranasal antifungals, surfactant irrigation, and intranasal antibiotics demonstrate little to no benefit, with some causing harm.

Conclusions:

• Intranasal steroids are a primary treatment for adult rhinosinusitis, with potential in pediatric populations.
• Saline irrigation is a safe and effective adjunct for specific rhinosinusitis types.
• Current evidence does not support the use of intranasal antifungals, surfactants, or antibiotics for rhinosinusitis.