Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyJune 2023
Nasal corticosteroids improve symptom scores and enrich the sinus microbiome.
Chronic rhinosinusitis (CRS) affects about 10% of the population. Current guidelines recommend first-line therapy with a daily nasal corticosteroid (either in a nasal spray or nasal irrigation) along with saline rinses (Int Forum Allergy Rhinol 2021; 11: 213 739). These recommendations are based on adult studies; data on children with CRS are scant.
Researchers in Poland randomised 63 children to 12 weeks of daily mometasone nasal spray with saline mists or saline alone. CRS was diagnosed by an otolaryngologist clinically on the basis of a European position paper (i.e. nasal congestion or nasal discharge, along with either facial pain/pressure or cough, for 12 weeks or more; Rhinology 2012; 50: 112). Only the nasal corticosteroid group had an improvement in Sinus and Nasal Quality of Life Survey scores from baseline and an increase in nasopharyngeal microbiome richness assessed by next-generation sequencing.
About half the children were allergic on skin testing, and the improvement was independent of the presence of atopy.
Comment: This was a small unblinded study, but it reassures us that nasal corticosteroids with saline rinses help alleviate CRS symptoms in children. For primary care physicians, it is reasonable to try two to three months of this treatment and then, if the patient is not better, refer the patient to an allergy or ear, nose and throat specialist. Also, it encourages us to withhold antibiotics initially and treat with anti-inflammatory agents, which might promote a healthier sinus microbiome.
David J. Amrol, MD, Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.
Latek M, et al. Effect of an intranasal corticosteroid on quality of life and local microbiome in young children with chronic rhinosinusitis: a randomized clinical trial. JAMA Pediatr 2023; 177: 345-352.
This summary is taken from the following Journal Watch titles: Pediatrics and Adolescent Medicine.