Decongestants, antihistamines and nasal irrigation for acute sinusitis in children

Traditional Chinese medicine in chronic rhinosinusitis: Mechanisms and postoperative recovery

BACKGROUND

Chronic rhinosinusitis (CRS) is inflammation of the sinuses and nasal passages that lasts for >3 months. Its pathogenesis is complex, treatment is difficult, and it has multiple effects on patients. Although surgical treatment can effectively relieve the symptoms, the recurrence rate is high, and there are postoperative complications such as infection. At present, nasal spray hormone, antibiotics and other western drugs are used in clinical treatment, but there are drug dependence and toxic side effects. However, traditional Chinese medicine (TCM) has made remarkable progress in the treatment and promotion of postoperative recovery, guided by its unique TCM theory, and has little toxic and side effects, providing more treatment options for patients.

PURPOSE

The review aims to elucidate the mechanism of CRS from the aspects of traditional medicine and modern medicine, and evaluate the influence of TCM compound, components of TCM, TCM nasal irrigation, TCM fumigation and other auxiliary treatment methods on CRS, providing a new perspective for the application of TCM in CRS.

METHODS

We conducted the literature retrieval with PubMed, Web of Science, Google Scholar and CNKI databases in a systematic manner (up to July 2024). The keywords included "sinusitis", "chronic rhinosinusitis", "nasal polyps", "herbal medicine", "medicinal plants", "traditional Chinese medicine", "oxidative stress", "pathogenic microbial", "anatomic structure" and so on. The obtained literatures were comprehensively sorted out. For image creation, Figdraw 2.0 was methodically employed.

RESULTS

The pathogenesis of CRS involves various interaction mechanisms such as bacterial biofilm formation, oxidative stress injury and impaired ciliary mucosa clearance. It is worth noting that TCM exerts therapeutic effects by targeting the above-mentioned pathological processes. Clinical studies have confirmed that TCM comprehensive therapy can significantly improve sinus symptom score, accelerate postoperative mucosal epithelialization, and promote postoperative rehabilitation of CRS. We also discussed the toxic side effects and clinical applications of related drugs.

CONCLUSION

In TCM, CRS is classified under the diagnostic category of Bi Yuan. Its pathogenesis is attributed to exogenous invasion of the six climatic pathogens (Liu Yin: wind, cold, summer heat, dampness, dryness, and fire), spleen-stomach qi deficiency, internal damp-heat accumulation, and qi-blood stasis. Guided by TCM principles, therapeutic strategies are individualized through syndrome differentiation, which tailors interventions to the patient's unique clinical manifestations. Therapeutic modalities include oral herbal formulations (e.g., decoctions or granules), acupuncture, and acupoint application. These approaches aim to restore physiological balance by harmonizing yin and yang, resolving meridian obstructions, and enhancing lung qi circulation to alleviate nasal congestion and improve ventilation.

Sinusitis

This study provides a comprehensive overview of sinusitis, detailing its pathophysiology, clinical manifestations, diagnostic criteria, and management strategies. Sinusitis, characterized by inflammation of the paranasal sinuses, can be acute, subacute, recurrent, or chronic, with distinct clinical presentations and treatment approaches. Diagnosis relies on clinical evaluation, imaging studies, and occasionally nasal endoscopy. Treatment encompasses both pharmacologic and non-pharmacological interventions, including antibiotics for bacterial cases and intranasal corticosteroids to reduce inflammation. Surgical interventions like functional endoscopic sinus surgery may be required for refractory cases. Emerging therapies, such as biologics and minimally invasive procedures, offer promising alternatives to traditional management approaches.

Decongestants, antihistamines and nasal irrigation for acute sinusitis in children

BACKGROUND

The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated.

OBJECTIVES

To determine the efficacy of decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children.

SEARCH METHODS

We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014).

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed each study for inclusion.

MAIN RESULTS

Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria.

AUTHORS' CONCLUSIONS

There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.

Intranasal steroids for acute sinusitis

BACKGROUND

Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school.

OBJECTIVES

We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children.

SEARCH METHODS

We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus.

MAIN RESULTS

No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS.

AUTHORS' CONCLUSIONS

Current evidence is limited for acute sinusitis confirmed by radiology or nasal endoscopy but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

Chronic rhinosinusitis in children

Chronic rhinosinusitis (CRS) affects nearly 37 million people in the United States each year and accounts for approximately $6 billion in direct and indirect health care costs. Despite its prevalence and significant impact, little is known about its exact cause and pathophysiology, and significant controversy remains regarding appropriate treatment options. Basic science research, however, has shown recent promise toward improving understanding of the innate and environmental factors underlying the pathophysiology of CRS. The hope is that this will also lead to advances in treatment for children adversely affected by this common yet complicated disease.

[Consensus document on the aetiology, diagnosis and treatment of sinusitis]

The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases, Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitis is presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. A proposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80mg/kg/day divided every 8hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed.