Are systemic corticosteroids effective in relieving symptoms of acute sinusitis?

Systemic corticosteroids are frequently used to treat acute sinusitis. A recent analysis of the Cochrane Central Register of Controlled Trials (CENTRAL) assess the effectiveness of systemic corticosteroids in relieving symptoms of acute sinusitis.

Four randomized controlled trials with a total of 1008 adult participants met the inclusion criteria. All participants received oral antibiotics and were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in three trials and non-steroidal anti-inflammatory drugs in one trial). In all trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at Days 3 to 7. An analysis of the three trials with placebo as a control treatment showed similar results but with a lesser effect size: No data on the long-term effects of oral corticosteroids on this condition, such as effects on relapse or recurrence rates was identified. Reported side effects of oral corticosteroids were limited and mild.

It was concluded that that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis. However, data are limited and there is a significant risk of bias. High quality trials assessing the efficacy of systemic corticosteroids both as an adjuvant and a monotherapy in primary care patients with acute sinusitis should be initiated.

Is there a link between acid reflux and chronic sinusitis?

Acid reflux into the oesophagus, larynx, pharynx or nasopharynx has been suggested as a causal factor in chronic rhino-sinusitis (CRS), which can then be refractory to nasal treatments. A recent review by Flook  & Kumar  (Rhinology 2011)  evaluated the strength of the link between acid reflux and nasal symptoms and CRS.

The authors evaluated 19 studies including those of proton pump inhibitors therapy. Four adult case-controlled studies showed more acid reflux events/symptoms in refractory CRS patients. Paediatric cohort studies showed more reflux events in rhinosinusitis patients than the general paediatric population, but they are not conclusive. Many of the papers did not use robust CRS diagnostic criteria for inclusion into studies and take no confounding factors into consideration.

The authors concluded that the evidence of a link between acid reflux with chronic sinusitis or any nasal symptoms is poor with no good randomised controlled trials available. The few adult studies that show any link between acid reflux and nasal symptoms were small case-controlled studies with moderate levels of potential bias. They found that there is not enough evidence to consider anti-reflux therapy for adult refractory CRS and there is no evidence that acid reflux is a significant causal factor in CRS.

Increase in the Frequency of Recovery of Methicillin Resistant Staphylococcus aureus (MRSA) in Acute and Chronic Maxillary Sinusitis

An increase in the recovery of MRSA was recently noted in various infectious sites including sinusitis. The presence  of MRSA in the infected sinus may not only lead to failure of antimicrobial therapy but can also serve as a potential source for the spread of these organisms to other body sites as well as an origin for dissemination to other individuals.

A recent study of 458 patients with maxillary sinusitis illustrated a significant increase in the recovery rate of MRSA in these patients. S. aureus was isolates from 8% of acute sinusitis patients between 2001-2003; and 30% were MRSA. The organism  was recovered from 10% of patients with acute sinusitis between 2004-2006; and 69% were MRSA ( p< .01). S. aureus was found in 16% of chronic sinusitis patients between 2001-2003; and 27% were MRSA. It was recovered from 20% of chronic sinusitis patients between 2004-2006; and 61% were MRSA ( p< .05). MRSA was isolated more often from patients who received previous antimicrobial therapy.

These findings suggest the need to suspect the presence of MRSA in sinusitis patients who had received previous antimicrobial therapy or do not or fail to improve after 48 hours of therapy.