So many published studies spend large amounts of time and money to show tiny improvements in care and which have large NNT (number needed to treat to help one person). It is refreshing and important to note studies that unequivocally change the standard of care and dramatically improve outcomes.

In a randomized, double-blinded, controlled trial of treatment of chronic rhinosinusitis (lasting greater than 3 months), researchers in Turkey found that the rate of improvement and cure of disease roughly doubled (based on symptoms, and CT-scan followup) when systemic steroids (a 15-day taper) were added to antibiotic treatment (30 days) in children and adolescents. (Number needed to treat about 2; see link to reference, below).

In other studies, inhaled nasal corticosteroids are a cornerstone of treatment of chronic sinusitis; it would be interesting to compare nasal corticosteroids to systemic corticosteroids (both with oral antibiotics) head-to-head in children.

In adults, UpToDate® recommends systemic corticosteroids only in specific cases: unraveling puzzling cases, to reduce swelling in fungal sinusitis, and for reducing the size of polyps in adults with chronic sinusitis associated with nasal polyposis.

Robert Moore, MD, MPH