8
Treatment
Table 4. Grade A/B Evidence-based Recommendations for
Medical Management of CRS
Intervention Grade Benefit Harm
CRSsNP:
Saline Irrigation,
Drops, Sprays
B Improvement in QoL,
endoscopic appearance,
and role in maintenance
therapy. Benefit over
control was shown with
saline irrigations (≥60 mL)
and at 8 weeks duration
Minor and rare adverse
effects. Nasal burning
and irritation are
more reported with
hypertonic irrigation.
See Table 9
CRSwNP:
Oral Corticosteroids
A Significant short-term
improvements in
subjective and objective
measures. Duration
may last 8–12 weeks in
conjunction with topical
INCS
GI symptoms, transient
adrenal suppression,
insomnia, and increased
bone turnover. All
established systemic
corticosteroid risks
exist, particularly with
prolonged treatment.
See Table 9
CRSsNP: Intranasal
Corticosteroid Spray
A Improved symptom scores,
improved endoscopy
scores
Epistaxis, nasal
irritation, headache.
See Table 9
CRSwNP: Intranasal
Corticosteroid Spray
A Improved symptoms,
endoscopy score, polyp
size, QoL, olfaction,
airway analysis (NPIF),
and polyp recurrence.
Magnitude of the clinical
effect is small
Epistaxis, nasal
irritation, headache.
See Table 9
CRSsNP:
Corticosteroid
Irrigations
A Improvement in
HR-QoL, subjective
symptom scores and
endoscopic appearance in
postoperative patients
Epistaxis, nasal
irritation. See Table 9.
No evidence of adrenal
suppression using
irrigation delivery
CRSwNP:
Non-Standard
Corticosteroid
Delivery
B Corticosteroid Irrigations/
Atomization Nebulization
have shown benefit over
INCS. Exhalation devices
have shown benefit over
placebo
Some evidence of
systemic absorption
with first generation
corticosteroids,
especially with multiple
modalities of therapy
