Use Of Intranasal Corticosteroids Research Articles

Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials

Intranasal corticosteroids (INCS) are prescribed for the long-term prophylactic treatment of inflammatory upper airway conditions. Although some systemic absorption can occur via topical routes, the clinical relevance is controversial. The effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity (LO) are well established, but the impact of the INCS is less well defined. This study aims to systematically review the literature for evidence of adverse occular events with INCS use. A systematic review of literature from Medline and Embase databases (January 1974 to 21st of November 2013) was performed. Using the PRISMA guidelines, all controlled clinical trials of patients using INCS, that reported original measures of IOP, LO, glaucoma or cataract incidences were included. Studies with adjuvant administration of oral, inhaled and intravenous steroids were excluded. 665 articles were retrieved with 137 were considered for full-text review. Of these, 116 (85%) were literature reviews and two were case reports. 19 studies (10 RCTs, 1 case-control, 8 case series) were included for the qualitative review, of which 18 reported data on IOP and 10 on cataract/LO. None (n=0) of the 10 RCT reporting data on glaucoma or IOP demonstrated changes in IOP compared to control. Also none (n=0) of the 6 RCTs reporting cataract or lens opacity demonstrated changes compared to control. Data from studies with low levels of bias, do not demonstrate a clinically relevant impact of INCS on neither ocular pressure, glaucoma, lens opacity nor cataract formation.

Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials.

Intranasal corticosteroids (INCS) are prescribed for the long-term prophylactic treatment of inflammatory upper airway conditions. Although some systemic absorption can occur via topical routes, the clinical relevance is controversial. The effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity (LO) are well established, but the impact of the INCS is less well defined. This study aims to systematically review the literature for evidence of adverse occular events with INCS use. A systematic review of literature from Medline and Embase databases (January 1974 to 21st of November 2013) was performed. Using the PRISMA guidelines, all controlled clinical trials of patients using INCS, that reported original measures of IOP, LO, glaucoma or cataract incidences were included. Studies with adjuvant administration of oral, inhaled and intravenous steroids were excluded. 665 articles were retrieved with 137 were considered for full-text review. Of these, 116 (85%) were literature reviews and two were case reports. 19 studies (10 RCTs, 1 case-control, 8 case series) were included for the qualitative review, of which 18 reported data on IOP and 10 on cataract/LO. None (n=0) of the 10 RCT reporting data on glaucoma or IOP demonstrated changes in IOP compared to control. Also none (n=0) of the 6 RCTs reporting cataract or lens opacity demonstrated changes compared to control. Data from studies with low levels of bias, do not demonstrate a clinically relevant impact of INCS on neither ocular pressure, glaucoma, lens opacity nor cataract formation.

Corticosteroids for the common cold.

The common cold is a frequent illness, which, although benign and self limiting, results in many consultations to primary care and considerable loss of school or work days. Current symptomatic treatments have limited benefit. Corticosteroids are an effective treatment in other upper respiratory tract infections and their anti-inflammatory effects may also be beneficial in the common cold. This updated review has included one additional study. To compare corticosteroids versus usual care for the common cold on measures of symptom resolution and improvement in children and adults. We searched Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 4), which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects (DARE) (2015, Issue 2), NHS Health Economics Database (2015, Issue 2), MEDLINE (1948 to May week 3, 2015) and EMBASE (January 2010 to May 2015). Randomised, double-blind, controlled trials comparing corticosteroids to placebo or to standard clinical management. Two review authors independently extracted data and assessed trial quality. We were unable to perform meta-analysis and instead present a narrative description of the available evidence. We included three trials (353 participants). Two trials compared intranasal corticosteroids to placebo and one trial compared intranasal corticosteroids to usual care; no trials studied oral corticosteroids. In the two placebo-controlled trials, no benefit of intranasal corticosteroids was demonstrated for duration or severity of symptoms. The risk of bias overall was low or unclear in these two trials. In a trial of 54 participants, the mean number of symptomatic days was 10.3 in the placebo group, compared to 10.7 in those using intranasal corticosteroids (P value = 0.72). A second trial of 199 participants reported no significant differences in the duration of symptoms. The single-blind trial in children aged two to 14 years, who were also receiving oral antibiotics, had inadequate reporting of outcome measures regarding symptom resolution. The overall risk of bias was high for this trial. Mean symptom severity scores were significantly lower in the group receiving intranasal steroids in addition to oral amoxicillin. One placebo-controlled trial reported the presence of rhinovirus in nasal aspirates and found no differences. Only one of the three trials reported on adverse events; no differences were found. Two trials reported secondary bacterial infections (one case of sinusitis, one case of acute otitis media; both in the corticosteroid groups). A lack of comparable outcome measures meant that we were unable to combine the data. Current evidence does not support the use of intranasal corticosteroids for symptomatic relief from the common cold. However, there were only three trials, one of which was very poor quality, and there was limited statistical power overall. Further large, randomised, double-blind, placebo-controlled trials in adults and children are required to answer this question.

Cost-effectiveness analysis of mometasone furoate versus beclomethasone dipropionate for the treatment of pediatric allergic rhinitis in Colombia.

IntroductionAllergic rhinitis (AR) is one of the most common chronic respiratory diseases observed in the pediatric population, producing a significant morbidity, and an economic burden due to direct medical costs and indirect costs. Despite the high prevalence of AR in children and the importance of the use of topical intranasal corticosteroids for its treatment, comparative analyses of alternative treatments in pediatric patients, in terms of both cost and effectiveness are lacking.MethodsA decision-analysis model was developed to estimate the cost-effectiveness of mometasone furoate nasal spray (MFNS) compared to beclomethasone dipropionate nasal spray (BDNS) for treating pediatric patients with AR over a 12-month period. Effectiveness parameters were obtained from a published study in which authors performed a systematic review of the literature. Cost data were obtained from a hospital´s bills and from the national manual of drug prices. The study assumed the perspective of the national healthcare in Colombia. The outcomes were three effectiveness measures summarized in a therapeutic index (TIX).ResultsFor the base-case analysis, the model showed that compared to BDNS, therapy with MFNS was associated with lower costs (US$229.78 vs. 289.74 average cost per patient over 12 months) and a greater improvement in TIX score (0.9724 vs. 0.8712 score points on average per patient over 12 months), thus leading to dominance.ConclusionThe present analysis shows that in Colombia, compared with BDNS, therapy with MFNS for treating pediatric patients with AR is a dominant strategy because it showed a greater improvement in a TIX reflecting both efficacy and safety, at lower total treatment costs.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0192-6) contains supplementary material, which is available to authorized users.

일측성 회전피판 및 비중격연골-대퇴근막 복합조직 이식에 의해 재건한 비중격 천공 증례

A 20-year-old male patient suffered from persistent nasal stuffiness and frequent epistaxis after prolonged use of intranasal corticosteroid for his allergic rhinitis. On physical examination, we observed a 1.5 cm sized septal perforation on the anterior portion of the nasal septum. Using inferior-based mucosal rotation flap for the left side and placing cartilage-Fascia lata composite graft between both sides of perforated septal mucosa, we repaired his septal perforation. After 6 months of the surgery, the perforation was completely healed. He has not suffered from any nasal osbtruction or epistaxis. (J Clinical Otolaryngol 2014;25:247-250)

Topical intranasal corticosteroids and growth velocity in children: a meta-analysis.

There is no consensus regarding the effects on growth velocity of intranasal topical corticosteroid (ITC) use in children. The objective of this study was to determine whether ITC use reduces growth velocity in children with allergic rhinitis (AR). A literature search of the National Center for Biotechnology Information PubMed, EMBASE, SCOPUS, and Cochrane databases from January 1, 1988 to October 7, 2013. The study selection was composed of randomized clinical trials investigating ITC for treatment of AR in children (age <18 years of age) with appropriate controls. Studies must have included interval change in growth as an outcome. Two authors independently extracted data and assessed study quality. Eligible studies were pooled using a random-effects approach. Eight studies with 755 participants from 3 countries provided data for the meta-analysis (knemometry, n =342 participants; stadiometry, n =413 participants). Study duration ranged from 2 to 4 weeks for trials evaluating knemometry outcomes, and 12 months for trials evaluating stadiometry outcomes. Age of participants ranged from 3 to 12 years. The pooled standardized mean difference showed that among studies using knemometry, mean growth was statistically significantly lower among children using ITC vs placebo (-.223 mm/week; 95% confidence interval [CI], -0.429 to -0.017; p < 0.034).The pooled standardized mean difference showed that among studies using stadiometry, there was no significant growth difference among children using ITC vs placebo (-0.053 cm/year; 95% CI, -0.491 to 0.385; p = 0.813). The limitations of this study were the difficulty in predicting longer-term or catch-up growth in children. Meta-analytic pooling of trials suggest that short-term ITC for the treatment of AR in children may decrease short-term growth velocity using knemometry; however, the effect on longer-term growth velocity as measured by stadiometry is unclear.

Impact of rhinitis on asthma severity in school-age children.

BackgroundIn a population-based sample of school-age children, we investigated factors associated with rhinitis, and differences between allergic and nonallergic rhinitis. Amongst children with asthma, we explored the association between rhinitis and asthma severity.MethodsChildren participating in a birth cohort study (n = 906) were reviewed at age 8 years. Asthma was defined as at least two of the following three features: physician-diagnosed asthma, currently using asthma medication and current wheeze. We measured lung function (plethysmography and spirometry) and airway hyper-reactivity (AHR; methacholine challenge).ResultsIn the analysis adjusted for the presence of asthma, children with rhinitis had significantly higher AHR (P = 0.001). Maternal smoking and absence of breastfeeding were stronger predictors of nonallergic rhinitis, whereas current wheeze and eczema were stronger predictors of allergic rhinitis. Amongst asthmatics (n = 159), when compared to 76 children without rhinitis, those with rhinitis (n = 83) were 2.89-fold (95% CI 1.41–5.91) more likely to experience frequent attacks of wheezing, 3.44-fold (1.19–9.94) more likely to experience severe attacks of wheezing limiting speech, 10.14-fold (1.27–81.21) more likely to have frequent visits to their doctor because of asthma and nine-fold (1.11–72.83) more likely to miss school. Reported use of intranasal corticosteroids resulted in a numerically small, but consistent reduction in risk, rendering the associations between rhinitis and asthma severity nonsignificant.ConclusionWe observed differences in risk factors and severity between allergic and nonallergic rhinitis. In children with asthma, rhinitis had adverse impact on asthma severity. The use of intranasal corticosteroids resulted in a small, but consistent reduction in the risk.

Intranasal steroids for acute sinusitis

Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children. We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies. Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus. No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS. Current evidence is limited for acute sinusitis confirmed by radiology or nasal endoscopy but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

Allergic Rhinoconjunctivitis in the Australian Population: Burden of Disease and Attitudes to Intranasal Corticosteroid Treatment

Allergic rhinoconjunctivitis (AR/C) is a global health problem causing significant morbidity and has a major impact on quality of life (QOL) and health expenditure. Despite the widespread prevalence, the overall health impact of AR/C may be underappreciated. The results of a survey designed to capture the burden of allergic rhinitis within the Asia-Pacific region have been published recently. Of particular note when evaluating treatment in this region was the fact that despite the value of intranasal corticosteroid (INCS) use, only a small percentage of patients used them. Whether this same trend is present within the population of Australian sufferers is unknown. This study examines the burden of AR/C and explores use of, and attitudes, to INCS sprays in the Australian population. Three hundred three completed interviews from adults and children who had physician-diagnosed AR/C and who were symptomatic or had received treatment in the previous 12 months were analyzed for QOL measures and attitudes to INCS use. Most patients surveyed had received their diagnosis from a general practitioner (GP), and in most cases, a GP provided the majority of ongoing medical care. Only 8% of respondents had consulted a relevant specialist. Diagnostic tests had not been performed in 55% of respondents. The major symptoms causing most distress were nasal congestion and ocular symptoms. The burden of AR/C was considerable; 42% described significant work or school interference because of symptoms, one-third reporting moderate-to-extreme interference with sleep. Despite the significant impact on QOL reported by this sample, 17% had never used INCS and 27% had not used them in the previous 12 months. Respondents' knowledge about INCSs was poor. AR/C is a common disease associated with significant morbidity and impairment of QOL. Improvement in diagnosis, management, and patient education is needed.

The Impact and Treatment of Allergic Rhinitis in the Middle East: A Comparison with the Landmark Allergy Surveys from Other Worldwide Regions

Allergic rhinitis is a global health problem that significantly affects quality of life. It is associated with illness, disability, health care costs, and comorbidities such as asthma. Between 2006 and 2011, a series of patient surveys were conducted covering the United States, Asia-Pacific, Latin America, and the Middle East. This article compares data regarding disease burden, treatment patterns, and patient expectations in Middle Eastern countries with those from other regions. The surveys highlighted the relatively low use of intranasal corticosteroids (INCSs), the current "gold standard" treatment for allergic rhinitis. This may be because of side effects, lack of efficacy, or reduced effectiveness over time. A higher proportion of patients in the Middle East reported bothersome side effects of their prescription nasal sprays, and a higher proportion of these patients strongly agreed that there were no truly effective treatments for allergic rhinitis. This suggests that health care practitioners in the Middle East should be encouraged to explain the use of INCSs in greater depth to their patients. There remains an unmet need in the treatment of nasal allergies worldwide. The allergy surveys highlight the key factors in choosing an INCS: fast, complete, and long-lasting symptom relief. There is opportunity for novel INCS treatments that address these needs while reducing troublesome side effects. Patient education must play a central role in treatment decision making, particularly in the Middle East, to achieve higher patient satisfaction.

The utility of using fiberoptic rhinoscopy in the diagnosis of nasal polyps

BackgroundSymtomatology of nasal polyps (NP) is relatively non-specific and other nasal conditions that cause nasal may be mistaken for NP. The purpose of this study was to evaluate the accuracy otoscopic (OT) examination in detecting presence of NP by using fiberoptic rhinoscopy (FR) as the gold standard to confirm diagnosis of NP.MethodsCharts from a single allergy clinic were reviewed for any patient having NP diagnosed by FR. Data collected included gender, age, allergy skin test results, and presence of asthma, aspirin allergy, previous nasal surgeries, intranasal corticosteroid use and leukotriene receptor antagonist use.ResultsThe OT examination had 44% sensitivity. In this study, more than half (56%) of patients with NP would have had their NP missed if FR had not been performed in addition to the OT examination.ConclusionsThe standard physical examination procedure is often not sufficient to confirm a diagnosis of NP. FR should be considered in the investigation of patients with rhinitis symptoms.

The use of Postoperative Topical Corticosteroids in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis

Topical intranasal corticosteroids (INCSs) are used to control disease symptoms in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). The evidence to recommend INCSs as part of the postoperative care is limited. This study was designed to assess the efficacy of INCSs in the postoperative care of patients undergoing functional endoscopic sinus surgery (FESS) during the 1st year postoperatively. We searched the Cochrane Central Register of Controlled Trials (1995 to May 2012), MEDLINE (January 1948 to May 2012), EMBASE (January 1980 to May 2012), and the reference lists of articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Randomized controlled trials (RCT) and cohort studies comparing INCSs with placebo or comparing different types of INCSs were included. Eleven studies (n = 945 patients) were RCTs and one prospective cohort study (n = 32 patients). As measured by the standardized mean difference (SMD) INCSs had a beneficial effect on symptom scores (SMD, -1.35; 95% CI, -2.05 to -0.64; p = 0.0002; 3 trials; 137 patients) and polyp score (SMD, 0.53; 95% CI, -0.91 to -0.14; p = 0.007; 5 trials; 223 patients). Compared with placebo, the use of INCSs decreased the odds of polyp recurrence (odds ratio, 0.17; 95% CI, 0.06-0.51; p = 0.002; 2 trials; 74 patients). Two RCTs (n = 105) and one cohort study (n = 32) reported normal adrenocorticotropic hormone levels postintervention. INCS use is a safe therapy in postoperative management of CRSwNP patients. INCS showed significant improvement in polyp score, patients' symptoms and significant decrease in polyp recurrence in the first year postoperatively.

Chapter 6: Nasal polyps.

Nasal polyps occur in 1-4% of the population, usually occurring in the setting of an underlying local or systemic disease. The most common associated condition is chronic rhinosinusitis (CRS). A high prevalence of nasal polyps is also seen in allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease, Churg-Strauss syndrome, and cystic fibrosis. In the setting of CRS, nasal polyps are not likely to be cured by either medical or surgical therapy; however, control is generally attainable. The best medical evidence supports the use of intranasal corticosteroids for maintenance therapy and short courses of oral corticosteroids for exacerbations. The evidence for short- and long-term antibiotics is much less robust. For patients with symptomatic nasal polyposis nonresponsive to medical therapies, functional endoscopic sinus surgery provides an adjunctive therapeutic option.

Medical therapy as the primary modality for the management of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a prevalent disease with many potential interventions including medical and surgical treatments. Because CRS is a chronic condition it is essential that therapy limits exacerbations. The purpose of this article is to show that literature supports the implementation of aggressive medical management as the mainstay of therapy for CRS. Scientific literature on the use of intranasal and systemic corticosteroids, antibiotics, nasal saline lavages, and unique therapies for individuals with CRS (both with and without nasal polyps) are reviewed. In addition, literature comparing outcomes of medical therapy versus surgical therapy are reviewed. There is ample evidence of the beneficial effects of intranasal corticosteroids (INCSs) in CRS. The literature also favors the use of systemic corticosteroids in acute exacerbations of disease in patients with nasal polyps. Although antibiotics are commonly used for acute sinusitis, there is also evidence of their potential value in CRS. The literature indicates that saline lavages show benefit in the treatment of CRS. In addition, there are promising new biological therapies on the horizon with mepoluzimab and omalizumab. At least one study comparing medical therapy versus surgical therapy for CRS found no advantage for either modality. Treatment of CRS with aggressive medical management can potentially postpone the need for surgical intervention. Clinicians should use INCSs and nasal saline lavages as maintenance therapy. Systemic corticosteroids and antibiotics should be used for acute exacerbations, especially in individuals with nasal polyps.

A multiallergen and miniscreen can change primary care provider diagnosis and treatment of rhinitis

A number of studies suggested that limited economical airborne allergy screening can successfully predict true respiratory allergy and be of use to primary care providers (PCPs) in improving the accuracy of their differential diagnosis and treatment of allergic rhinitis. More accurate diagnosis would lead to proper use of intranasal corticosteroids, intranasal antihistamines, and oral antihistamines. However, to date, there have been no reports of an actual application of the screens by PCPs. This study was designed to measure the potential impact of providing a limited multiallergen and miniscreen (MAMS) by in vitro allergy testing on PCP diagnosis and treatment of rhinitis, properly differentiating seasonal allergic rhinitis, perennial allergic rhinitis, vasomotor rhinitis, and mixed rhinitis. Two hundred adult and adolescent patients who presented to PCPs for rhinitis symptoms were enrolled from July to November of 2007. They signed informed consent and a serum specimen for MAMS was obtained. The PCPs answered a questionnaire concerning their diagnosis and treatment before and after the MAMS results were revealed to the PCP. The PCPs changed or modified the original diagnosis in 139 of 200 patients. Originally, 182 subjects had an allergic rhinitis diagnosis. After the results of the MAMS were known, 113 continued with an allergic rhinitis diagnosis. Vasomotor or nonallergic rhinitis diagnoses increased from 18 to 87 cases. Use of MAMS can help PCPs make a more accurate diagnosis and offer better therapy to patients with rhinitis.

Patterns of Intranasal Corticosteroid Use Among Individuals Diagnosed with Allergic Rhinitis: Evidence from a Large Claims Database

Patterns of Intranasal Corticosteroid Use Among Individuals Diagnosed with Allergic Rhinitis: Evidence from a Large Claims Database

Suicide and Prescription Rates of Intranasal Corticosteroids and Nonsedating Antihistamines for Allergic Rhinitis

To estimate the relationship between antiallergy drug prescription rates and suicide across the United States and over time. The relationship between allergy, allergens, and suicidal behavior and suggestions of a possible immune mediation led us to hypothesize that intranasal corticosteroids, known to reduce local airway production of T-helper cell type 2 cytokines, may be associated with reduced risk of suicide relative to antihistamines, which only secondarily affect cytokine production. The authors evaluated the relationship of suicide rates at the county level in the United States (N = 120,076 suicides) with prescriptions for intranasal corticosteroids and nonsedating antihistamines, in interaction with antidepressant prescriptions and other socioeconomic variables, for the period from 1999 to 2002. Suicide rate data were derived from state vital record systems based on local death certificate registries, and county-level allergy and antidepressant prescription data were obtained from IMS Health Incorporated (Plymouth Meeting, Pennsylvania). The prescription volume of intranasal corticosteroids was associated with a lower suicide risk (P = .0004), while that of antihistamines was associated with a modestly greater suicide risk (P = .0001). Adjustment for antidepressant prescriptions did not affect these relationships. This is the first study, to our knowledge, to find a possible association between completed suicide and medications for allergic rhinitis and also the first report of an association of intranasal corticosteroid use with a lower suicide rate. This association should be considered preliminary and deserving of further investigation.

Bilateral central serous chorioretinopathy caused by intranasal corticosteroids: A case report and review of the literature

The relationship between systemic corticosteroids and central serous chorioretinopathy (CSCR) has been well established; however, there also appears to be an association with intranasal corticosteroids. A search of the English literature revealed only three reported cases of CSCR linked to intranasal corticosteroid use, and in each, clinical improvement was observed after cessation of the steroid agent. We present an additional case of bilateral CSCR resulting from intranasal corticosteroid use and review the literature regarding this uncommon side effect. Otolaryngologists, as frequent prescribers of these medications, should be aware of their myriad side effects, including ophthalmologic conditions such as CSCR.

The Use of Intranasal Corticosteroids in Children

Objective: Investigate the use of intranasal corticosteroids (ICS) by otolaryngologists with a predominantly pediatric practice, a national inquiry has been conducted in a European country. Method: Participants: 212 otolaryngologists, representing around 10% of the specialty, answered the survey (M/F ratio=179/33). The mean age of this population was 52 ± 8.4 years, with a mean time in practice of 20.7 ± 9 years. Results: Disease treated by ICS were chronic rhinosinusitis in 39.2% for a mean duration of 30 days in 62.2% of the cases, aergic rhinitis in 69.2 %, nasal polyposis in 67.2%, and OME in 30.2%. Acute rhinosinusitis was considered for treatment by intranasal corticosteroids by only 8.5% of otolaryngologists. Adenoid hypertrophy was treated in 16% of cases by ICS. Symptoms considered for treatment by ICS were nasal obstruction (88.6%), rhinorrhea (67.6%), nasal itching (66.1%), ocular symptoms (41.2%), sneezing (63%), olfactory troubles (73.2%), dyspnea (76%), edema of nasal mucosa (76.2%). Fever was never an indication (75%). Conclusion: According to this nationwide survey nasal polyposis and allergic rhinitis are the most frequent indications for ICS treatment in children.

The link between otitis media with effusion and allergy: A potential role for intranasal corticosteroids

We reviewed the evidence linking otitis media with effusion (OME) and atopy, with the goal of clarifying the possible role of intranasal corticosteroids (INSs) in OME treatment. In August 2009, the MEDLINE database was searched for primary studies on OME epidemiology, pathophysiology, and treatment. Relevant clinical guidelines were obtained. Interpreting OME research is complicated by variable disease definitions, patient populations, methodologies, and outcomes assessments, along with the possibility of spontaneous resolution. However, evidence links OME with atopic conditions including allergic rhinitis; observed prevalence of allergic rhinitis in patients with chronic or recurrent OME ranges from 24% to 89%. Such findings have prompted evaluations of common allergy medications for OME treatment. While short-term use of INSs alone or combined with antibiotics has shown benefit in some studies, more prolonged treatment protocols and long-term clinical outcomes will require critical assessment. Evidence suggesting epidemiologic and pathophysiologic links between allergy and OME has prompted investigation into a potential role for INSs in OME management, with promising initial results. Benefits of considering medical treatment in patients with OME prior to surgery include both the potential reductions in allergic inflammation and the naturally occurring spontaneous resolution of OME in these patients.