Corticosteroids Hasten Sinusitis Relief

Intranasal spray helps speed drainage, says study

WEDNESDAY, Dec. 26, 2001 (HealthDayNews) -- Inhaling corticosteroids through the nose may quicken relief from painful sinus infections, says new research.

Adding the therapy to the conventional treatment for patients who suffer from repeated or chronic sinus infections may cure more cases, says a report in today's issue of the Journal of the American Medical Association.

One expert says the finding could change the standard treatment for patients with chronic or recurrent sinusitis.

Sinusitis is an infection of the sinuses, the cavities behind the nose that normally drain into the nasal passages. A cold or a bout with allergy can inflame the sinuses, blocking drainage and leading to infection. This can cause symptoms including pain, tenderness, fever, runny nose and a cough that worsens at night.

People with asthma, allergies or hay fever are at risk for chronic sinusitis, as are those with a history of nasal obstruction, such as a deviated septum and cysts or polyps that block drainage of the sinuses.

"Sinusitis is a big problem in the United States," says study author Dr. Rowena J. Dolor of Duke University Medical Center. Every year, Americans make more than 30 million doctor visits for sinusitis-related symptoms, resulting in health expenditures of roughly $5.8 billion.

In her clinical experience, Dolor had found that acute, recurrent sinusitis and chronic sinusitis were very difficult to treat. Some studies had suggested that intranasal corticosteroids -- cortisone-like medicines -- helped relieve the symptoms, but more solid evidence was needed.

Between October 1998 and April 2000, Dolor and her colleagues enrolled 95 volunteers at 22 different medical centers. The patients, whose median age was 39, all had a history of sinusitis, and X-ray or endoscopy exams had shown signs of infection.

Half the patients were assigned to inhale 200 micrograms (two puffs) per nostril once daily for 21 days of the intranasal corticosteroid fluticasone propionate. The other half received a placebo spray.

Twice daily for three days, all volunteers also were given two puffs per nostril of the decongestant xylometazoline hydrochloride. Each volunteer also took 250 milligrams of the antibiotic cefuroxime axetil twice daily for 10 days. The drug maker GlaxoSmithKline, which funded the study, provided the antibiotics and corticosteroid sprays.

The 88 patients who completed the follow-up kept daily records of for eight weeks after the treatments began, and they also were interviewed by telephone 10, 21 and 56 days after the therapy started.

Dolor found that 93.5 percent of patients who received the corticosteroid treatment were cured of their infection, compared with 73.9 percent of the patients who received the placebo spray.

She also found that patients using the corticosteroids improved faster, recording recoveries in roughly six days, compared with 9.5 days for the placebo group.

"We think that what the intranasal corticosteroids do is that they reduce inflammation and mucosal [swelling] that occurs in the nose and in the openings of the sinuses. This is believed to promote drainage and hasten the elimination of infectious organisms or bacteria," says Dolor.

Dolor also says the nasal decongestants opened the passages to give the corticosteroids better distribution into the nasal passages and the sinuses.

"The only side effects that people see are … mild nosebleed," says Dolor.

While people who experience a single, uncomplicated attack of sinusitis may only require antibiotics, Dolor says the study points to a different treatment course for patients whose condition is not so simple.

"Patients with recurrent sinusitis and chronic symptoms should receive the corticosteroid along with their antibiotics and possibly a nasal decongestant," she says. "We used the steroids for three weeks, but there are probably some folks who will need to continue the intranasal steroids for longer, especially those with chronic symptoms."

Dr. Richard Waguespack, an otolaryngologist in private practice in Birmingham, Ala., says the results in Dolor's patients represents a significant improvement in patient cure rate.

"It definitely got people better quicker," says Waguespack. "Since these topical steroids are very safe, then it would certainly be a reasonable thing to add [to therapies] in many of our patients that get sick repeatedly."

"I wouldn't be surprised if it doesn't become more of a standard of care," he says.

In future studies, Dolor says she would like to see if intranasal corticosteroids also help one-time cases of simple, acute sinusitis.

What to Do: For more about sinusitis, check the American Academy of Otolaryngology, Sinusis.Com or the National Institute of Allergy and Infectious Diseases.

SOURCES: Interviews with Rowena J. Dolor, M.D., M.H.S., associate, Division of Internal Medicine, Duke University Medical Center, Durham, N.C.; Richard W. Waguespack, M.D., otolaryngologist in private practice, Birmingham, Ala.; Dec. 26, 2001, Journal of the American Medical Association
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