Acute sinusitis is one of the commonest illnesses seen in general practice. The inflammation of the sinuses is accompanied by unpleasant symptoms such as a nasal discharge, congestion and, sometimes, facial pain and fever. It can be severe enough to lead to time off work or school. The knowledge in a new Cochrane review shows that intranasal steroids might help. They should reduce the inflammation, making drainage and aeration of the sinuses easier, speeding up the elimination of the virus or bacteria that caused the infection.

The authors of the Cochrane review looked for randomised trials comparing topical, intranasal steroids with a placebo or no intervention. The steroids could be applied by drops or spray. Trials in both adults and children were eligible. The outcome of most interest to the reviewers was the proportion of patients whose symptoms eased or cleared up completely.

Four trials are included, with a total of nearly 2000 children and adults. All of these patients were diagnosed on the basis of signs and symptoms, and also using radiology or endoscopy. As well as these four trials, the authors of the Cochrane review found three more from which they are hoping to obtain data for inclusion in the next update of this review.

One of the included trials was done in a single centre. The other three were multi-centre, multi-national or both. All the trials had a randomisation for intranasal steroid versus placebo, with treatment lasting two or three weeks. In addition, one trial compared two different doses of steroid with placebo, and one trial had four treatment groups: two different doses of steroid, an antibiotic and placebo.

The Cochrane reviews' main meta-analyses of resolution or improvement of symptoms could be done with three trials, including about 1800 patients. This was measured at two or three weeks in the three trials and the authors found that the proportion of people whose symptoms improved or cleared up completely, rose from about 66% in the placebo group to 73% in the group allocated to steroids. This means that for every 1000 patients given intranasal steroids, 70 more, on average, will experience some benefit over the next few weeks.

The authors conclude that the knowledge contained in their review is sufficient to support the use of intranasal corticosteroids for acute sinusitis. These could be given either as the sole treatment or in combination with other treatments. However, they still suggest a need for further large scale randomised evidence. Such trials would provide better estimates of the effects of the drugs on symptoms and other outcomes. They might also show the relevance of the findings in circumstances where diagnosis is based only on signs and symptoms.

This Cochrane review is available in full at www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005149/frame.html

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June 4 2007