Intranasal Treatment of Acute Rhinosinusitis - Recommendations, Efficacy and Safety
DOI:
https://doi.org/10.12775/JEHS.2023.15.01.005Keywords
rhinosinusitis, acute rhinosinusitis, common cold, nasal decongestants, nasal corticosteroids, nasal salineAbstract
Introduction and purpose: Acute rhinosinusitis is a common condition worldwide, usually caused by respiratory viruses. Nasal epithelium is their primary point of entry and an active responder to the infection. Therefore, it seems reasonable for the treatment approach to include locally applied drugs. Our purpose is to bring forward up-to-date recommendations of intranasal treatment options for acute rhinosinusitis, and assess their efficacy and safety.
Description of the state of knowledge: Rhinosinusitis is an inflammation of the mucosa present in the nose and the paranasal sinuses. It affects many patients yearly, bearing significant adverse effects on quality of life, productivity and healthcare expenditure. Acute rhinosinusitis lasts less than 12 weeks and is divided into viral, post-viral and acute bacterial rhinosinusitis. It is one of the prevailing reasons for unfounded antibiotics prescription, although it is usually self-limiting. Its treatment depends on the clinical stage of the infection, however, each of them encloses medications administered intranasally. Based on EPOS2020 and scientific publications it seems that nasal decongestants may be prescribed in viral rhinosinusitis, nasal corticosteroids in post-viral rhinosinusitis and nasal saline can prove beneficial in all clinical stages of rhinosinusitis. While used appropriately all aforementioned medications prove to be safe.
Conclusions: In the light of the findings presented in this paper, it can be concluded that acute rhinosinusitis should be treated not only with oral, but also with intranasal drugs. Nasal decongestants are to be considered in viral rhinosinusitis mainly. Nasal corticosteroids show some positive effect in post-viral rhinosinusitis. Nasal saline can be administered in all clinical stages of acute rhinosinusitis. It is crucial to caution the patients against misuse of the medications, in order to prevent their adverse effects.
References
Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018 Feb 1;73(suppl_2):ii2-ii10. doi: 10.1093/jac/dkx504. PMID: 29490062; PMCID: PMC5890730.
Eckel N, Sarganas G, Wolf IK, Knopf H. Pharmacoepidemiology of common colds and upper respiratory tract infections in children and adolescents in Germany. BMC Pharmacol Toxicol. 2014 Aug 9;15:44. doi: 10.1186/2050-6511-15-44. PMID: 25106446; PMCID: PMC4131226.
Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013 Jun 4;2013(6):CD000247. doi: 10.1002/14651858.CD000247.pub3. PMID: 23733381; PMCID: PMC7044720.
Jaume F, Quintó L, Alobid I, Mullol J. Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study). BMJ Open. 2018 Jan 31;8(1):e018788. doi: 10.1136/bmjopen-2017-018788. PMID: 29391364; PMCID: PMC5878244.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb 20;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600. PMID: 32077450.
Tan KS, Yan Y, Ong HH, Chow VTK, Shi L, Wang DY. Impact of Respiratory Virus Infections in Exacerbation of Acute and Chronic Rhinosinusitis. Curr Allergy Asthma Rep. 2017 Apr;17(4):24. doi: 10.1007/s11882-017-0693-2. PMID: 28389843; PMCID: PMC7088794.
Tan KS, Ong HH, Yan Y, Liu J, Li C, Ong YK, Thong KT, Choi HW, Wang DY, Chow VT. In Vitro Model of Fully Differentiated Human Nasal Epithelial Cells Infected With Rhinovirus Reveals Epithelium-Initiated Immune Responses. J Infect Dis. 2018 Mar 5;217(6):906-915. doi: 10.1093/infdis/jix640. PMID: 29228279.
Tan KS, Yan Y, Koh WLH, Li L, Choi H, Tran T, Sugrue R, Wang Y, Chow VT. Comparative Transcriptomic and Metagenomic Analyses of Influenza Virus-Infected Nasal Epithelial Cells From Multiple Individuals Reveal Specific Nasal-Initiated Signatures. Front Microbiol. 2018 Nov 14;9:2685. doi: 10.3389/fmicb.2018.02685. PMID: 30487780; PMCID: PMC6246735.
Yan Y, Tan KS, Li C, Tran T, Chao SS, Sugrue RJ, Shi L, Chow VT, Wang DY. Human nasal epithelial cells derived from multiple subjects exhibit differential responses to H3N2 influenza virus infection in vitro. J Allergy Clin Immunol. 2016 Jul;138(1):276-281.e15. doi: 10.1016/j.jaci.2015.11.016. Epub 2016 Jan 21. PMID: 26806046.
Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020. Curr Allergy Asthma Rep. 2020 Jun 3;20(7):28. doi: 10.1007/s11882-020-00917-5. PMID: 32495003; PMCID: PMC7266914.
Wyler B, Mallon WK. Sinusitis Update. Emerg Med Clin North Am. 2019 Feb;37(1):41-54. doi: 10.1016/j.emc.2018.09.007. PMID: 30454779.
Platt M. Pharmacotherapy for allergic rhinitis. Int Forum Allergy Rhinol. 2014 Sep;4 Suppl 2:S35-40. doi: 10.1002/alr.21381. PMID: 25182353.
Cox DR, Wise SK. Medical Treatment of Nasal Airway Obstruction. Otolaryngol Clin North Am. 2018 Oct;51(5):897-908. doi: 10.1016/j.otc.2018.05.004. Epub 2018 Jun 18. PMID: 29914725.
Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi: 10.1002/14651858.CD009612.pub2. PMID: 27748955; PMCID: PMC6461189.
Morris S, Eccles R, Martez SJ, Riker DK, Witek TJ. An evaluation of nasal response following different treatment regimes of oxymetazoline with reference to rebound congestion. Am J Rhinol. 1997 Mar-Apr;11(2):109-15. doi: 10.2500/105065897782537197. PMID: 9129752.
Watanabe H, Foo TH, Djazaeri B, Duncombe P, Mackay IS, Durham SR. Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis. Rhinology. 2003 Sep;41(3):167-74. PMID: 14579657.
Wahid NWB, Shermetaro C. Rhinitis Medicamentosa. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30855902.
Robison JG, Pant H, Ferguson BJ. Rhinitis medicamentosa as a cause of increased intraoperative bleeding. Laryngoscope. 2010 Oct;120(10):2106-7. doi: 10.1002/lary.21074. PMID: 20824778.
Keyserling HF, Grimme JD, Camacho DL, Castillo M. Nasal septal perforation secondary to rhinitis medicamentosa. Ear Nose Throat J. 2006 Jun;85(6):376, 378-9. PMID: 16866112.
Okano M. Mechanisms and clinical implications of glucocorticosteroids in the treatment of allergic rhinitis. Clin Exp Immunol. 2009 Nov;158(2):164-73. doi: 10.1111/j.1365-2249.2009.04010.x. Epub 2009 Aug 6. PMID: 19737138; PMCID: PMC2768806.
Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2013 Dec 2;2013(12):CD005149. doi: 10.1002/14651858.CD005149.pub4. PMID: 24293353; PMCID: PMC6698484.
Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med. 2016 May 2;11:18. doi: 10.1186/s40248-016-0054-3. PMID: 27141307; PMCID: PMC4852427.
Meltzer EO, Bardelas J, Goldsobel A, Kaiser H. A preference evaluation study comparing the sensory attributes of mometasone furoate and fluticasone propionate nasal sprays by patients with allergic rhinitis. Treat Respir Med. 2005;4(4):289–96.
Meltzer E, Stahlman JE, Leflein J, Meltzer S, Lim J, Dalal AA, et al. Preferences of adult patients with allergic rhinitis for the sensory attributes of fluticasone furoate versus fluticasone propionate nasal sprays: a randomized, multicenter, double-blind, single-dose, crossover study. Clin Ther. 2008;30(2):271–9.
Yonezaki M, Akiyama K, Karaki M, Goto R, Inamoto R, Samukawa Y, et al. Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis. Auris Nasus Larynx. 2015;S0385–8146(15):00208–4.
Mehle ME. Are nasal steroids safe? Curr Opin Otolaryngol Head Neck Surg. 2003 Jun;11(3):201-5. doi: 10.1097/00020840-200306000-00013. PMID: 12923363.
Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 Suppl):S1–84.
Verret DJ, Marple BF. Effect of topical nasal steroid sprays on nasal mucosa and ciliary function. Curr Opin Otolaryngol Head Neck Surg. 2005 Feb;13(1):14-8. doi: 10.1097/00020840-200502000-00005. PMID: 15654209.
Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-767. doi: 10.1016/j.jaci.2020.07.007. Epub 2020 Jul 22. PMID: 32707227.
Chitsuthipakorn W, Kanjanawasee D, Hoang MP, Seresirikachorn K, Snidvongs K. Benefits of nasal saline treatment in acute rhinosinusitis: Systematic review and meta-analysis. Int Forum Allergy Rhinol. 2022 Aug;12(8):1006-1017. doi: 10.1002/alr.22957. Epub 2022 Jan 14. PMID: 34971301.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Maria Sadlik, Leila Abod, Natalia Ilnicka, Daria Matyja, Patrycja Zuziak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 463
Number of citations: 0