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Systematic review
Best evidence supports topical corticosteroids and routine saline irrigations for medical treatment of chronic rhinosinusitis
  1. John S Schneider
  1. Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to : Dr John S Schneider, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8115, St. Louis, MO 63110, USA; schneiderj{at}

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Chronic rhinosinusitis (CRS) affects between 7% and 15.5% of the US population. In Europe, the latest estimates put prevalence at 10.9%.1 ,2 The condition produces symptoms such as nasal congestion, facial pressure/pain, purulent nasal drainage and is associated with significant fatigue and decreased productivity. While complications from the disease are rare, CRS is often treated with antibiotics, based on an older understanding that CRS results from bacterial infection. Newer data strongly suggest that CRS results from chronic inflammation of the sinonasal mucosa.3 Among otolaryngologists, the treatment strategy has shifted towards the use of antiinflammatory medications, such as topical and systemic corticosteroids. Choosing the optimal, …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.