{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:28:19Z","timestamp":1791804499538,"version":"4.3.4"},"reference-count":74,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T00:00:00Z","timestamp":1349654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence\u2010based approach for the utilization of topical therapies in the management of CRS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review of the literature was performed and the guidelines for development of an evidence\u2010based review with recommendations were followed. Study inclusion criteria were: adult population &gt;18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end\u2010point. We focused on reporting higher\u2010quality studies (level 2b or higher), but reported on lower\u2010level studies if the topic contained insufficient evidence. We excluded drug\u2010eluting spacer and stent therapy from this review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are <jats:italic>recommended<\/jats:italic> in the topical treatment of CRS. Nonstandard (off\u2010label) topical sinonasal steroid therapies can be an <jats:italic>option<\/jats:italic> for managing CRS. The evidence <jats:italic>recommends against<\/jats:italic> the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21096","type":"journal-article","created":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T17:11:38Z","timestamp":1349716298000},"page":"281-298","source":"Crossref","is-referenced-by-count":151,"title":["Topical therapies in the management of chronic rhinosinusitis: an evidence\u2010based review with recommendations"],"prefix":"10.1002","volume":"3","author":[{"given":"Luke","family":"Rudmik","sequence":"first","affiliation":[{"name":"Endoscopic Sinus and Skull Base Surgery Division of Otolaryngology\u2013Head and Neck Surgery Department of Surgery University of Calgary  Calgary, Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Hoy","sequence":"additional","affiliation":[{"name":"Endoscopic Sinus and Skull Base Surgery Division of Otolaryngology\u2013Head and Neck Surgery Department of Surgery University of Calgary  Calgary, Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney J.","family":"Schlosser","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Rhinology and Sinus Surgery Applied Medical Research Center St Vincents Hospital University of New South Wales and Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Loyola University Medical Center  Maywood IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Lund","sequence":"additional","affiliation":[{"name":"Professional Unit Royal National Throat Nose and Ear Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Oregon Health and Science University  Portland OR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,10,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21847"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810391852"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.04.020"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20095"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2007.06.726"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/hn.2003.v128.amhn0312811"},{"key":"e_1_2_6_8_1","unstructured":"Oxford Centre for Evidence\u2010based Medicine (CEBM). 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