{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T12:06:33Z","timestamp":1770465993381,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re\u2010examination of the current literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo\u2010controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (\u0394) and response rates (odds ratio).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten trials (N\u00a0=\u00a0751) were included for meta\u2010analysis, with a mean age of 47.5 years (range: 18\u201380 years; 95% confidence interval [CI]: 43.9\u201351.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (\u03940.4; 95% CI: 0.3\u20130.6; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (\u03940.4; 95% CI: 0.1\u20130.7; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.01), but not with topical spray (\u03940.04; 95% CI: \u22120.9 to 1.0; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9\u20136.0; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001; OR: 12.4; 95% CI: 1.8\u201383.8; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9\u20134.0; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.12).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.23367","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T13:39:42Z","timestamp":1716557982000},"page":"1477-1487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3744-3174","authenticated-orcid":false,"given":"Akash M.","family":"Bhat","sequence":"first","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Drexel University College of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke D.","family":"Heiland","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"},{"name":"Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun A.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-9075","authenticated-orcid":false,"given":"Vinay K.","family":"Rathi","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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 South Carolina USA"},{"name":"Department of Surgery Ralph H. Johnson VA Medical Center  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary M.","family":"Soler","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Sinus Surgery Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.3142"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2022.01.016"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22741"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin20.600"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.Cd009274"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.08.006"},{"key":"e_1_2_7_8_1","volume-title":"The Oxford Levels of Evidence 2","author":"Howick J","year":"2011"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010003\u20130713\u20139"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200205000\u201000015"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino09.178"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.12.016"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.201900036"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.8013"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0895\u20104356(01)00377\u20108"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20132222.2004.02044.x"},{"issue":"2","key":"e_1_2_7_19_1","first-page":"57","article-title":"Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients","volume":"42","author":"Lund VJ","year":"2004","journal-title":"Rhinology"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325\u2010010\u20130105\u20137"},{"issue":"2","key":"e_1_2_7_21_1","first-page":"103","article-title":"Influence of topical steroid treatment on maxillary sinusitis","volume":"30","author":"Qvarnberg Y","year":"1992","journal-title":"Rhinology"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(86)90051\u20106"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.0667"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2023.04.013"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22851"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22586"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22646"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23302"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23210"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28152"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.23367","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T05:36:21Z","timestamp":1725082581000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.23367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1002\/alr.23367"],"URL":"https:\/\/doi.org\/10.1002\/alr.23367","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]},"assertion":[{"value":"2024-03-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}