Topical therapy in the management of chronic rhinosinusitis

PURPOSE OF REVIEW: A comprehensive literature review was conducted to evaluate the efficacy of various topical therapies of chronic rhinosinusitis (CRS): saline, antibiotics, corticosteroids, and antifungals. Emerging new studies can provide the necessary amendments to improve the treatment for CRS. RECENT FINDINGS: Saline was more effective in treating CRS when administered with increased tonicity or through large volume, low positive pressure devices. Contamination rates of irrigation bottles were insufficient to outweigh the benefits of saline. Corticosteroids were effective in treating CRS with or without nasal polyps and reducing the chance of repeat endoscopic sinus surgery with manageable adverse effects and minimal systemic absorption. Antibiotics improved the quality of life of CRS patients, especially when it was culture directed or administered through a nebulizer in low-level studies. However, high-level studies showed antibiotics performed similarly to saline with additional risk of systemic absorption. Topical antifungal therapy did not demonstrate efficacy in CRS. SUMMARY: In conclusion, topical saline and corticosteroids should be considered as the first line of therapy; hypertonic saline is recommended over isotonic solution if side effects are well tolerated. Additional studies are required to evaluate the efficacy of topical antibiotics with improved delivery methods. Also, to accurately assess the systemic absorption risk of topical corticosteroids and antibiotics, currently utilized measures need to be modified.