9
Cost
Benefit-Harm
Assessment Policy Level
Low Preponderance of
benefit over harm
Recommendation: Saline irrigation
improves symptoms, QoL and nasal
endoscopy. Duration should be >8 weeks.
Hypertonic saline is more effective but
may be more irritating than isotonic
saline. ere is no advantage of heated
over room temperature saline. Devices
with volume >60 mL bring
greater benefits
Low Preponderance of
benefit over harm with
short-term treatment
with follow-up
Strong recommendation: For short-term
management of CRSwNP. Longer term
use is not supported by the literature and
carries increased risk of harm
Low to
Moderate
Possible mild benefit
over harm
Option: Standard metered dose INCS
could be used in treatment of CRSsNP,
particularly if primary symptoms are that
of rhinitis
Low to
Moderate
Benefit outweighs harm Strong recommendation: INCS are
recommended for CRSwNP before or
aer sinus surgery. Consideration for
twice daily dosing if initial treatment
effect is small
Moderate to
High
Preponderance of
benefit over harm, with
increased cost compared
to nasal sprays
Recommended: Post-operative patients
Option: Non-surgical/medical
management
Moderate Benefit outweighs
harm compared with
oral corticosteroids
but caution in patients
on multiple topical
therapies
If not controlled with INCS, strong
recommendation for corticosteroid
irrigation; recommendation for
atomization/nebulization.
Option: Exhalation delivery
