12
Treatment
Table 4. Grade A/B Evidence-based Recommendations for
Medical Management of CRS
Intervention Grade Benefit Harm
CRSwNP:
Anti-Leukotrienes
A Improvement in
symptoms comparable to
INCS. May have limited
benefit as an adjunct to
INCS
Limited risks.
Montelukast associated
with neuropsychiatric
events. Zileuton
associated with elevated
liver enzymes requiring
monitoring.
See Table 9
CRSs/wNP:
Xylitol Irrigation
B Symptomatic
improvement in
the 2 small RCTs in
postoperative patients
Occasional local
discomfort, stinging
CRSs/wNP:
Colloidal Silver
B (−) No benefit for use in
clinical studies
Potential increase in
serum silver levels
CRSwNP:
Furosemide
B Reduced recurrence of
nasal polyps following ESS
over placebo nasal spray
No studies have been
performed to assess
systemic safety with
nasal delivery
CRSwNP (AERD):
ASA Desensitization
A Reduced postop polyp
recurrence, increased QoL
and reduced symptoms.
Reduced need for systemic
corticosteroids and
surgical revisions
GI bleeding, increased
morbidity in renal
disease and clotting
dysfunction at high
maintenance doses.
<3% GI side effects with
low-dose protocols
(cont'd)
