Scolaris Content Display Scolaris Content Display

Search history flow diagram.
Figures and Tables -
Figure 1

Search history flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.1 Overall symptom scores.
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Figure 4

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.1 Overall symptom scores.

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.20 Proportion of responders (reduction in polyp size).
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Figure 5

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.20 Proportion of responders (reduction in polyp size).

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.26 Polyp recurrence after surgery.
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Figure 6

Forest plot of comparison: 1 Topical steroid versus placebo, outcome: 1.26 Polyp recurrence after surgery.

Comparison 1 Topical steroid versus placebo, Outcome 1 Overall symptom scores.
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Analysis 1.1

Comparison 1 Topical steroid versus placebo, Outcome 1 Overall symptom scores.

Comparison 1 Topical steroid versus placebo, Outcome 2 Overall symptom scores by sinus surgery status.
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Analysis 1.2

Comparison 1 Topical steroid versus placebo, Outcome 2 Overall symptom scores by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 3 Overall symptom scores by topical delivery methods.
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Analysis 1.3

Comparison 1 Topical steroid versus placebo, Outcome 3 Overall symptom scores by topical delivery methods.

Comparison 1 Topical steroid versus placebo, Outcome 4 Overall symptom scores by polyp severity.
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Analysis 1.4

Comparison 1 Topical steroid versus placebo, Outcome 4 Overall symptom scores by polyp severity.

Comparison 1 Topical steroid versus placebo, Outcome 5 Overall symptom scores by steroid agent.
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Analysis 1.5

Comparison 1 Topical steroid versus placebo, Outcome 5 Overall symptom scores by steroid agent.

Comparison 1 Topical steroid versus placebo, Outcome 6 Overall symptom scores by quality of studies.
Figures and Tables -
Analysis 1.6

Comparison 1 Topical steroid versus placebo, Outcome 6 Overall symptom scores by quality of studies.

Comparison 1 Topical steroid versus placebo, Outcome 7 Proportion of responders (overall improvement in symptom).
Figures and Tables -
Analysis 1.7

Comparison 1 Topical steroid versus placebo, Outcome 7 Proportion of responders (overall improvement in symptom).

Comparison 1 Topical steroid versus placebo, Outcome 8 Change in nasal obstruction score.
Figures and Tables -
Analysis 1.8

Comparison 1 Topical steroid versus placebo, Outcome 8 Change in nasal obstruction score.

Comparison 1 Topical steroid versus placebo, Outcome 9 Change in nasal obstruction score by sinus surgery status.
Figures and Tables -
Analysis 1.9

Comparison 1 Topical steroid versus placebo, Outcome 9 Change in nasal obstruction score by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 10 Change in nasal obstruction score by topical delivery method.
Figures and Tables -
Analysis 1.10

Comparison 1 Topical steroid versus placebo, Outcome 10 Change in nasal obstruction score by topical delivery method.

Comparison 1 Topical steroid versus placebo, Outcome 11 Change in nasal obstruction score by polyp severity.
Figures and Tables -
Analysis 1.11

Comparison 1 Topical steroid versus placebo, Outcome 11 Change in nasal obstruction score by polyp severity.

Comparison 1 Topical steroid versus placebo, Outcome 12 Change in nasal obstruction score by steroid agent.
Figures and Tables -
Analysis 1.12

Comparison 1 Topical steroid versus placebo, Outcome 12 Change in nasal obstruction score by steroid agent.

Comparison 1 Topical steroid versus placebo, Outcome 13 Change in nasal obstruction score by quality of studies.
Figures and Tables -
Analysis 1.13

Comparison 1 Topical steroid versus placebo, Outcome 13 Change in nasal obstruction score by quality of studies.

Comparison 1 Topical steroid versus placebo, Outcome 14 Proportion of responders in nasal obstruction.
Figures and Tables -
Analysis 1.14

Comparison 1 Topical steroid versus placebo, Outcome 14 Proportion of responders in nasal obstruction.

Comparison 1 Topical steroid versus placebo, Outcome 15 Polyp score.
Figures and Tables -
Analysis 1.15

Comparison 1 Topical steroid versus placebo, Outcome 15 Polyp score.

Comparison 1 Topical steroid versus placebo, Outcome 16 Polyp score by sinus surgery status.
Figures and Tables -
Analysis 1.16

Comparison 1 Topical steroid versus placebo, Outcome 16 Polyp score by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 17 Polyp score by topical delivery methods.
Figures and Tables -
Analysis 1.17

Comparison 1 Topical steroid versus placebo, Outcome 17 Polyp score by topical delivery methods.

Comparison 1 Topical steroid versus placebo, Outcome 18 Change in polyp score.
Figures and Tables -
Analysis 1.18

Comparison 1 Topical steroid versus placebo, Outcome 18 Change in polyp score.

Comparison 1 Topical steroid versus placebo, Outcome 19 Change in polyp score by sinus surgery status.
Figures and Tables -
Analysis 1.19

Comparison 1 Topical steroid versus placebo, Outcome 19 Change in polyp score by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 20 Proportion of responders (reduction in polyp size).
Figures and Tables -
Analysis 1.20

Comparison 1 Topical steroid versus placebo, Outcome 20 Proportion of responders (reduction in polyp size).

Comparison 1 Topical steroid versus placebo, Outcome 21 Proportion of responders (reduction in polyp size) by sinus surgery status.
Figures and Tables -
Analysis 1.21

Comparison 1 Topical steroid versus placebo, Outcome 21 Proportion of responders (reduction in polyp size) by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 22 Proportion of responders (reduction in polyp size) by topical delivery methods.
Figures and Tables -
Analysis 1.22

Comparison 1 Topical steroid versus placebo, Outcome 22 Proportion of responders (reduction in polyp size) by topical delivery methods.

Comparison 1 Topical steroid versus placebo, Outcome 23 Proportion of responders (reduction in polyp size) by polyp severity.
Figures and Tables -
Analysis 1.23

Comparison 1 Topical steroid versus placebo, Outcome 23 Proportion of responders (reduction in polyp size) by polyp severity.

Comparison 1 Topical steroid versus placebo, Outcome 24 Proportion of responders (reduction in polyp size) by steroid agent.
Figures and Tables -
Analysis 1.24

Comparison 1 Topical steroid versus placebo, Outcome 24 Proportion of responders (reduction in polyp size) by steroid agent.

Comparison 1 Topical steroid versus placebo, Outcome 25 Proportion of responders (reduction in polyp size) by quality of studies.
Figures and Tables -
Analysis 1.25

Comparison 1 Topical steroid versus placebo, Outcome 25 Proportion of responders (reduction in polyp size) by quality of studies.

Comparison 1 Topical steroid versus placebo, Outcome 26 Polyp recurrence after surgery.
Figures and Tables -
Analysis 1.26

Comparison 1 Topical steroid versus placebo, Outcome 26 Polyp recurrence after surgery.

Comparison 1 Topical steroid versus placebo, Outcome 27 Polyp recurrence after surgery by quality of studies.
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Analysis 1.27

Comparison 1 Topical steroid versus placebo, Outcome 27 Polyp recurrence after surgery by quality of studies.

Comparison 1 Topical steroid versus placebo, Outcome 28 Peak nasal inspiratory flow.
Figures and Tables -
Analysis 1.28

Comparison 1 Topical steroid versus placebo, Outcome 28 Peak nasal inspiratory flow.

Comparison 1 Topical steroid versus placebo, Outcome 29 Olfactory score.
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Analysis 1.29

Comparison 1 Topical steroid versus placebo, Outcome 29 Olfactory score.

Comparison 1 Topical steroid versus placebo, Outcome 30 Peak nasal inspiratory flow by topical delivery methods.
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Analysis 1.30

Comparison 1 Topical steroid versus placebo, Outcome 30 Peak nasal inspiratory flow by topical delivery methods.

Comparison 1 Topical steroid versus placebo, Outcome 31 Change in nasal airflow.
Figures and Tables -
Analysis 1.31

Comparison 1 Topical steroid versus placebo, Outcome 31 Change in nasal airflow.

Comparison 1 Topical steroid versus placebo, Outcome 32 Proportion of responders (improvement in airflow).
Figures and Tables -
Analysis 1.32

Comparison 1 Topical steroid versus placebo, Outcome 32 Proportion of responders (improvement in airflow).

Comparison 1 Topical steroid versus placebo, Outcome 33 Change in CT score.
Figures and Tables -
Analysis 1.33

Comparison 1 Topical steroid versus placebo, Outcome 33 Change in CT score.

Comparison 1 Topical steroid versus placebo, Outcome 34 Change in olfactory threshold test.
Figures and Tables -
Analysis 1.34

Comparison 1 Topical steroid versus placebo, Outcome 34 Change in olfactory threshold test.

Comparison 1 Topical steroid versus placebo, Outcome 35 Proportion of responders (improvement in olfaction‐subjective).
Figures and Tables -
Analysis 1.35

Comparison 1 Topical steroid versus placebo, Outcome 35 Proportion of responders (improvement in olfaction‐subjective).

Comparison 1 Topical steroid versus placebo, Outcome 36 Peak nasal inspiratory flow by sinus surgery status.
Figures and Tables -
Analysis 1.36

Comparison 1 Topical steroid versus placebo, Outcome 36 Peak nasal inspiratory flow by sinus surgery status.

Comparison 1 Topical steroid versus placebo, Outcome 37 Quality of life (SF36) Physical component summary.
Figures and Tables -
Analysis 1.37

Comparison 1 Topical steroid versus placebo, Outcome 37 Quality of life (SF36) Physical component summary.

Comparison 1 Topical steroid versus placebo, Outcome 38 Quality of life (SF36) Mental component summary.
Figures and Tables -
Analysis 1.38

Comparison 1 Topical steroid versus placebo, Outcome 38 Quality of life (SF36) Mental component summary.

Study

Steroid group 1 n (%)

Placebo group n (%)

Steroid group 2 n (%)

Aukema 2005

1 (3.7)

6 (22.2)

Bross‐Soriano 2004

0 (0)

0 (0)

0 (0)

Chalton 1985

0 (0)

0 (0)

Dijkstra 2004

4 (30.8)

7 (33.3)

14 (54.3)

Dingsor 1985

3 (15)

2 (9.5)

Drettner 1982

3 (21.4)

0 (0)

Ehnhage 2009

7 (23.3)

6 (17.1)

Filiaci 2000

3 (7.7)

6 (16.2)

2 (4.9)

Hartwig 1988

4 (11.1)

6 (16.2)

Holmberg 1997

4 (21.1)

7 (38.9)

2 (11.1)

Holmström 1999

1 (1.9)

2 (3.8)

Holopainen 1982

0 (0)

1 (11.1)

Jankowski 2001

7 (14.6)

5 (11.1)

Jankowski 2009

27 (16.5)

19 (23.5)

Johansen 1993

NA

NA

Johansson 2002

0 (0)

0 (0)

Jorissen 2009

11 (23.9)

13 (28.9)

Keith 2000

1 (1.9)

5 (9.6)

Lang 1983

0 (0)

0 (0)

Lildholdt 1995

2 (4.5)

2 (5)

2 (4.8)

Lund 1998

3 (30)

4 (44.4)

0 (0)

Mastalerz 1997

0 (0)

0 (0)

Mygind 1975

0 (0)

0 (0)

Olsson 2010

4 (13.3)

4 (10.5)

Penttila 2000

4 (8.5)

10 (21.3)

2 (4.2)

Rowe‐Jones 2005

11 (20)

26 (48.1)

Ruhno 1990

0 (0)

0 (0)

Small 2005

14 (12.2)

22 (18.8)

Stjarne 2006

8 (7.8)

19 (17.9)

9 (8.8)

Stjarne 2006b

19 (12.4)

19 (17.9)

Stjarne 2009

36 (45.6)

43 (53.8)

Tos 1998

0 (0)

0 (0)

0 (0)

Vento 2012

9 (30)

8 (26.7)

Vlckova 2009

0 (0)

3 (5.5)

Figures and Tables -
Analysis 1.39

Comparison 1 Topical steroid versus placebo, Outcome 39 Drop‐outs.

Study

Steroid group n (%)

Placebo group n (%)

Description of events reported

Remarks

Chur 2010

There was no difference in 24‐hour urinary free cortisol change in all groups

Dijkstra 2004

The incidence of epistaxis was not higher in the steroid group

Dingsor 1985

6 (30)

10 (48)

Itching, sore throat, sneeze, blood traces, nausea

No patients had abnormal plasma cortisol

Drettner 1982

4 (36)

7 (64)

Nasal irritation, blood stained mucus, nasal crust, eye irritation, cataract, pharynx irritation

Ehnhage 2009

22 (73)

18 (47)

70% mild, 23% moderate, 7% serious severity

Filiaci 2000

Viral infection, abdominal pain, bronchitis, respiratory infection

80% are mild to moderate

Hartwig 1988

9 (25)

1 (3)

Nose bleed, nasal irritation

Holmström 1999

14 (14)

18 (18)

Epistaxis, throat irritation, nose dryness

There was no change in morning serum cortisol and no difference between treatment groups in the overall frequency of adverse events

Holopainen 1982

Transient nasal stinging and slight throat irritation

Mean morning plasma cortisol was not different between before and 4 months after treatment in both groups. Local SE were mild in both groups.

Jankowski 2001

16 (33)

5 (11)

Blood‐tinged nasal secretion, headache, bronchospasm

Most events are mild or moderate

Jankowski 2009

The incidence of adverse events was similar in all groups

Johansen 1993

Dry nose, headache, epistaxis

No differences between treatment groups

Jorissen 2009

10 (63)

16 (62)

Headache, sinusitis, cold

Rare serious events

Keith 2000

12 (23)

9 (17)

Epistaxis, headache, viral respiratory infection

No serious events. No difference between groups in serum cortisol level.

Lildholdt 1995

Epistaxis, dryness

No serious events

Lund 1998

7 (70)

3 (33)

Asthma, respiratory infection, headache

No serious events

Mygind 1975

8 (44)

0 (0)

Nasal infection

Penttila 2000

21 (45)

27 (57)

Respiratory infection, epistaxis

No serious events. No difference in incidence of events between groups.

Ruhno 1990

6 (33.3)

5 (27.8)

Headache, epistaxis, dizziness

No serious events

Small 2005

56 (49)

64 (55)

Epistaxis and headache

Most adverse events are mild or moderate and unrelated to study treatment

Stjarne 2006

54 (53)

54 (51)

Respiratory infection, headache, epistaxis

Most adverse events are mild or moderate

Stjarne 2006b

93 (61)

68 (47)

Epistaxis

Most adverse events are mild or moderate. All epistaxis were mild.

Stjarne 2009

11 (14)

9 (11)

Epistaxis, dyspepsia, obstruction, headache,
sneezing, nausea, nasal congestion, rhinorrhoea, skin irritation

Most adverse events are mild or moderate

Tos 1998

Respiratory infection, nasal mucosal blood, rhinitis, bronchospasm, headache

No serious events

Vento 2012

13‐17 (43‐57)

16‐19 (55‐63)

Drying, crusting, blood in secretion

No serious events. No differences between treatment groups.

Vlckova 2009

13 (24)

11 (20)

Epistaxis

No serious adverse events. Morning plasma cortisol was not changed.

Figures and Tables -
Analysis 1.40

Comparison 1 Topical steroid versus placebo, Outcome 40 Adverse events.

Comparison 1 Topical steroid versus placebo, Outcome 41 Overall symptom scores by source of funding.
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Analysis 1.41

Comparison 1 Topical steroid versus placebo, Outcome 41 Overall symptom scores by source of funding.

Comparison 1 Topical steroid versus placebo, Outcome 42 Change in nasal obstruction score by source of funding.
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Analysis 1.42

Comparison 1 Topical steroid versus placebo, Outcome 42 Change in nasal obstruction score by source of funding.

Comparison 1 Topical steroid versus placebo, Outcome 43 Proportion of responders (reduction in polyp size) by source of funding.
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Analysis 1.43

Comparison 1 Topical steroid versus placebo, Outcome 43 Proportion of responders (reduction in polyp size) by source of funding.

Comparison 1 Topical steroid versus placebo, Outcome 44 Overall symptom scores (post hoc).
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Analysis 1.44

Comparison 1 Topical steroid versus placebo, Outcome 44 Overall symptom scores (post hoc).

Comparison 1 Topical steroid versus placebo, Outcome 45 Proportion of responders (overall improvement in symptom: post hoc).
Figures and Tables -
Analysis 1.45

Comparison 1 Topical steroid versus placebo, Outcome 45 Proportion of responders (overall improvement in symptom: post hoc).

Comparison 1 Topical steroid versus placebo, Outcome 46 Proportion of responders (reduction in polyp size: post hoc).
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Analysis 1.46

Comparison 1 Topical steroid versus placebo, Outcome 46 Proportion of responders (reduction in polyp size: post hoc).

Comparison 2 Topical steroid versus no intervention, Outcome 1 Change in endoscopy score.
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Analysis 2.1

Comparison 2 Topical steroid versus no intervention, Outcome 1 Change in endoscopy score.

Comparison 2 Topical steroid versus no intervention, Outcome 2 Change in CT score.
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Analysis 2.2

Comparison 2 Topical steroid versus no intervention, Outcome 2 Change in CT score.

Comparison 2 Topical steroid versus no intervention, Outcome 3 Disease‐specific quality of life.
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Analysis 2.3

Comparison 2 Topical steroid versus no intervention, Outcome 3 Disease‐specific quality of life.

Study

Steroid group 1 n (%)

No intervention group n (%)

Steroid group 2 n (%)

El Naggar 1995

0 (0)

0 (0)

Karlsson 1982

0 (0)

0 (0)

Rotenberg 2011

1 (4.8)

1 (4.5)

2 (9.5)

Figures and Tables -
Analysis 2.4

Comparison 2 Topical steroid versus no intervention, Outcome 4 Drop‐outs.

Study

Steroid group 1 mean IOC (SD)

No intervention mean IOC (SD)

Steroid group 2 mean IOC (SD)

Remarks

Rotenberg 2011

13.4 (2.1)

13.1 (2.8)

12.9 (2.6)

No difference between groups in IOC (intraocular pressure) and adrenocorticotropic hormone levels

Figures and Tables -
Analysis 2.5

Comparison 2 Topical steroid versus no intervention, Outcome 5 Adverse events.

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 1 Symptom scores.
Figures and Tables -
Analysis 3.1

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 1 Symptom scores.

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 2 Proportion of responders (improvement in symptoms).
Figures and Tables -
Analysis 3.2

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 2 Proportion of responders (improvement in symptoms).

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 3 Change in polyp score.
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Analysis 3.3

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 3 Change in polyp score.

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 4 Proportion of responders (reduction in in polyp size).
Figures and Tables -
Analysis 3.4

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 4 Proportion of responders (reduction in in polyp size).

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 5 Polyp recurrence after surgery.
Figures and Tables -
Analysis 3.5

Comparison 3 Low‐dose steroid versus high‐dose steroid, Outcome 5 Polyp recurrence after surgery.

Table 1. Summary of outcomes

 

Symptoms

Polyp size

Polyp recurrence

Aukema 2005

Favours steroid over placebo for obstruction (P = 0.0001), rhinorrhoea (P = 0.003), mucus in throat (P = 0.03) and loss of smell (P = 0.04). No difference for facial pain (P value not shown) and headache (P = 0.76).

Favours steroid over placebo (P = 0.038)

NA

Bross‐Soriano 2004

NA

NA

Favours steroid (fluticasone 14.8% and beclomethasone 25.9%) over placebo (44.4%)

Chalton 1985

NA

Favours steroid over placebo (P < 0.05)

NA

Chur 2010

Favours steroid bid (‐40%) over od (‐30%) and placebo (‐28%)

Favours steroid bid (‐34%) over od (‐26%) and placebo (‐24%)

NA

Dijkstra 2004

NA

NA

No difference (P value not shown)

Dingsor 1985

Favours steroid over placebo (P < 0.05) for obstruction. No difference for rhinorrhoea and sneezing.

Favours steroid over placebo P < 0.03

Favours steroid over placebo P < 0.05

Drettner 1982

Favours steroid over placebo (P < 0.05)

No difference  (P value not shown)

Favours steroid (0.0%) over placebo (27.3%)

Ehnhage 2009

No difference (P value not shown)

No difference (P value not shown)

NA

El Naggar 1995

NA

NA

NA

Filiaci 2000

Favours steroid (all doses) over placebo (P < 0.01)

Favours steroid (140 µg bid; P < 0.014 and 280 µg od; P = 0.009) over placebo. No difference for 140 µg od and placebo (P value not shown).

NA

Hartwig 1988

No difference  (P value not shown)

Favours steroid over placebo (P value not shown)

NA

Holmberg 1997

Favours fluticasone (86%) over placebo (0%) in the percentage of days with an overall scores of zero (P < 0.05). No difference between beclomethasone (19%) and placebo.

NA

NA

Holmström 1999

NA

No difference  (P value not shown)

NA

Holopainen 1982

No difference  (P value not shown)

Favours steroid over placebo for polyp number and size (P value not shown)

NA

Jankowski 2001

Favours steroid (all doses)  over placebo (P < 0.01)

Favours steroid (all doses) than placebo (P < 0.01)

NA

Jankowski 2009

Favours steroid (P = 0.0001)

Favours steroid (P < 0.01 for right nostrils, P < 0.001 for left nostrils)

NA

Johansen 1993

Favours steroid over placebo for both spray and aerosol (P value not given)

Favours steroid over placebo (P < 0.01 for both spray and aerosol)

NA

Johansson 2002

Favours steroid over placebo (P = 0.0017)

No difference (P = 0.12)

NA

Jorissen 2009

No difference  (P = 0.09)

No difference  (P = 0.34)

NA

Jurkiewicz 2004

Favours steroid over placebo (P < 0.01)

Favours steroid over placebo (P < 0.01)

NA

Karlsson 1982

NA

Favours steroid over placebo (P = 0.003)

NA

Keith 2000

No difference  (P value not shown)

No difference  (P value not shown)

NA

Lang 1983

No difference  (P value not shown)

No difference  (P value not shown)

NA

Lildholdt 1995

Favours steroid over placebo (P < 0.001 for both doses)

Favours steroid over placebo (P < 0.001 for 200 µg bid and < 0.05 for 400 µg bid)

NA

Lund 1998

No difference for overall symptoms and sense of smell. Favours beclomethasone dipropionate (P = 0.01), but not fluticasone (P = 0.1) over placebo for nasal blockage. Facial pain and headache not reported.

Favours fluticasone over placebo (P = 0.04). No difference between beclomethasone dipropionate and placebo (P = 0.13).

NA

Mastalerz 1997

Favours steroid over placebo (P < 0.05)

NA

NA

Mygind 1975

Favours steroid over placebo (P value not shown)

No difference (P > 0.1)

NA

Olsson 2010

NA

NA

NA

Passali 2003

NA

NA

Favours steroid (24.2%) over placebo (30%, P value not shown)

Penttila 2000

1. Favours steroid bid over placebo for rhinitis (P < 0.001) and nasal blockage (P < 0.05) but not sense of smell (P value not shown)
2. Favours steroid od for rhinitis (P < 0.05) but not nasal blockage and sense of smell (P value not shown)

Favours steroid bid in proportion of responders (41%) over placebo (15%) (P < 0.01). No difference for steroid od (24%) and placebo (P value not shown).

NA

Rotenberg 2011

NA

NA

NA

Rowe‐Jones 2005

No difference (P = 0.23 for "How do you feel overall" VAS, P = 0.39 for total VAS)

Favours steroid over (P = 0.02)

NA

Ruhno 1990

1. No difference (P value not shown)
2. Favours steroid od over placebo for obstruction (P = 0.005)

NA

NA

Small 2005

1. Favours steroid od over placebo for obstruction (P < 0.001), rhinorrhoea (P < 0.05), post nasal drip (P < 0.001) and loss of smell (P < 0.01)
2.Favours steroid bid over placebo for obstruction (P < 0.001), rhinorrhoea (P < 0.001), post nasal drip (P < 0.01) and loss of smell (P < 0.05)

Favours steroid over placebo (P < 0.001 for od and P = 0.01 for bid )

NA

Stjarne 2006

1. Favours steroid od over placebo for obstruction and rhinorrhoea (P < 0.05 both). No difference for post nasal drip and loss of smell.
2. Favours steroid bid over placebo for obstruction (P < 0.01), rhinorrhoea (P < 0.01) and post nasal drip (P < 0.05). No difference for loss of smell.

Favours steroid bid over placebo (P = 0.04). No difference between steroid od and placebo.

NA

Stjarne 2006b

Favours steroid  over placebo (P < 0.005)

Favours steroid in proportion of responders (41%) over placebo (27%), P = 0.003

NA

Stjarne 2009

1. Favours steroid for rhinorrhoea (P = 0.04)
2. No difference for congestion and sense of smell (P value not shown)

NA

Favours steroid (33%) over placebo (44%)

Tos 1998

Favours steroid over placebo (both spray and turbuhaler, P < 0.001)

Favours steroid over placebo (both spray and turbuhaler, P < 0.001)

NA

Vento 2012

NA

NA

NA

Vlckova 2009

Favours steroid over placebo (P < 0.001)

1. Favours steroid for polyp score over placebo (P < 0.001)
2. Favours steroid (57%) for proportion of responders over placebo (9%) (P < 0.001)

NA

bid: twice daily
NA: not applicable (outcomes are not assessed)
od: once daily
VAS: visual analogue scale

Figures and Tables -
Table 1. Summary of outcomes
Comparison 1. Topical steroid versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Overall symptom scores Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

2 Overall symptom scores by sinus surgery status Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

2.1 Patients with sinus surgery

4

250

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.32 [‐0.58, ‐0.07]

2.2 Patients without sinus surgery

3

195

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.64 [‐0.93, ‐0.35]

3 Overall symptom scores by topical delivery methods Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

3.1 Nasal spray

5

343

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.32 [‐0.53, ‐0.10]

3.2 Nasal aerosol

1

35

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.87 [‐1.57, ‐0.17]

3.3 Nasal turbuhaler

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.06 [‐1.58, ‐0.55]

4 Overall symptom scores by polyp severity Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

4.1 Patients with small size polyps

2

124

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.69 [‐1.05, ‐0.33]

4.2 Patients with large size polyps

1

35

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.87 [‐1.57, ‐0.17]

4.3 Patients with all size polyps

4

286

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.32 [‐0.56, ‐0.08]

5 Overall symptom scores by steroid agent Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

5.1 Budesonide

3

183

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.63 [‐0.93, ‐0.33]

5.2 Mometasone furoate

1

91

Std. Mean Difference (IV, Fixed, 95% CI)

0.34 [‐0.07, 0.75]

5.3 Fluticasone propionate

2

136

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐1.04, ‐0.35]

5.4 Beclomethasone dipropionate

1

35

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.87 [‐1.57, ‐0.17]

6 Overall symptom scores by quality of studies Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

6.1 Studies with high quality

6

415

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.45 [‐0.65, ‐0.26]

6.2 Studies with medium quality

1

30

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.57 [‐1.30, 0.16]

7 Proportion of responders (overall improvement in symptom) Show forest plot

4

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.71 [1.29, 2.26]

8 Change in nasal obstruction score Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

9 Change in nasal obstruction score by sinus surgery status Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

9.1 Patients with sinus surgery

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

9.2 Patients without sinus surgery

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Change in nasal obstruction score by topical delivery method Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

10.1 Nasal drop

3

223

Std. Mean Difference (IV, Fixed, 95% CI)

1.00 [‐1.28, ‐0.71]

10.2 Nasal spray

3

186

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐1.21, ‐0.59]

10.3 Nasal aerosol

1

73

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐0.62, 0.30]

11 Change in nasal obstruction score by polyp severity Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

11.1 Patients with small size polyps

2

213

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.94 [‐1.23, ‐0.65]

11.2 Patients with large size polyps

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 Patients with all size polyps

5

269

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.71 [‐0.97, ‐0.46]

12 Change in nasal obstruction score by steroid agent Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

12.1 Fluticasone propionate

4

332

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.04, ‐0.58]

12.2 Flunisolide

1

41

Std. Mean Difference (IV, Fixed, 95% CI)

‐2.04 [‐2.81, ‐1.27]

12.3 Budesonide

2

109

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.50 [‐0.89, ‐0.11]

13 Change in nasal obstruction score by quality of studies Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

13.1 Studies with high quality

5

344

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.19 [‐1.43, ‐0.96]

13.2 Studies with medium quality

2

138

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.38, 0.29]

14 Proportion of responders in nasal obstruction Show forest plot

5

680

Risk Ratio (M‐H, Fixed, 95% CI)

1.43 [1.27, 1.61]

15 Polyp score Show forest plot

3

202

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.49 [‐0.77, ‐0.21]

16 Polyp score by sinus surgery status Show forest plot

3

202

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.49 [‐0.77, ‐0.21]

16.1 Patients with sinus surgery

2

104

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.21, ‐0.41]

16.2 Patients without sinus surgery

1

98

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.17 [‐0.57, 0.22]

17 Polyp score by topical delivery methods Show forest plot

3

202

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.49 [‐0.77, ‐0.21]

17.1 Nasal spray

2

139

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.36 [‐0.70, ‐0.02]

17.2 Nasal aerosol

1

63

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.78 [‐1.30, ‐0.27]

18 Change in polyp score Show forest plot

3

237

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.73 [1.00, ‐0.46]

19 Change in polyp score by sinus surgery status Show forest plot

3

237

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.73 [1.00, ‐0.46]

19.1 Patients with sinus surgery

2

144

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.19 [‐1.54, ‐0.83]

19.2 Patients without sinus surgery

1

93

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.53, 0.28]

20 Proportion of responders (reduction in polyp size) Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

21 Proportion of responders (reduction in polyp size) by sinus surgery status Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

21.1 Patients with sinus surgery

4

325

Risk Ratio (M‐H, Fixed, 95% CI)

3.22 [2.10, 4.93]

21.2 Patients without surgery

4

460

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.23, 2.17]

22 Proportion of responders (reduction in polyp size) by topical delivery methods Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

22.1 Nasal drop

4

328

Risk Ratio (M‐H, Fixed, 95% CI)

2.31 [1.52, 3.50]

22.2 Nasal spray

4

457

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [1.50, 2.63]

23 Proportion of responders (reduction in polyp size) by polyp severity Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

23.1 Patients with small size polyps

6

457

Risk Ratio (M‐H, Fixed, 95% CI)

2.59 [1.83, 3.65]

23.2 Patients with all size polyps

2

328

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [1.22, 2.30]

24 Proportion of responders (reduction in polyp size) by steroid agent Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

24.1 Fluticasone propionate

4

407

Risk Ratio (M‐H, Fixed, 95% CI)

2.86 [1.94, 4.22]

24.2 Beclomethasone

1

32

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.30, 2.46]

24.3 Mometasone furoate

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [1.10, 2.13]

24.4 Betamethasone

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

4.5 [1.16, 17.44]

24.5 Budesonide

1

18

Risk Ratio (M‐H, Fixed, 95% CI)

3.2 [0.93, 11.05]

25 Proportion of responders (reduction in polyp size) by quality of studies Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

25.1 Studies with high quality

5

623

Risk Ratio (M‐H, Fixed, 95% CI)

2.13 [1.65, 2.76]

25.2 Studies with medium quality

3

162

Risk Ratio (M‐H, Fixed, 95% CI)

1.91 [1.11, 3.29]

26 Polyp recurrence after surgery Show forest plot

6

437

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.45, 0.79]

27 Polyp recurrence after surgery by quality of studies Show forest plot

6

437

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.45, 0.79]

27.1 Studies with high quality

2

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.47, 0.98]

27.2 Studies with medium or low quality

4

237

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.33, 0.79]

28 Peak nasal inspiratory flow Show forest plot

7

587

Mean Difference (IV, Fixed, 95% CI)

22.04 [13.29, 30.80]

29 Olfactory score Show forest plot

1

109

Mean Difference (IV, Fixed, 95% CI)

‐0.45 [‐0.64, ‐0.26]

30 Peak nasal inspiratory flow by topical delivery methods Show forest plot

7

676

Mean Difference (IV, Fixed, 95% CI)

23.18 [15.24, 31.12]

30.1 Nasal drop

1

54

Mean Difference (IV, Fixed, 95% CI)

50.0 [‐5.42, 105.42]

30.2 Nasal spray

6

622

Mean Difference (IV, Fixed, 95% CI)

22.62 [14.60, 30.64]

31 Change in nasal airflow Show forest plot

3

204

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.57 [‐0.85, ‐0.29]

32 Proportion of responders (improvement in airflow) Show forest plot

2

66

Risk Ratio (M‐H, Fixed, 95% CI)

1.91 [1.13, 3.22]

33 Change in CT score Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐1.02 [‐3.31, 1.27]

34 Change in olfactory threshold test Show forest plot

1

68

Mean Difference (IV, Fixed, 95% CI)

‐1.5 [‐3.05, 0.05]

35 Proportion of responders (improvement in olfaction‐subjective) Show forest plot

1

298

Risk Ratio (M‐H, Fixed, 95% CI)

1.66 [1.15, 2.40]

36 Peak nasal inspiratory flow by sinus surgery status Show forest plot

7

587

Mean Difference (IV, Fixed, 95% CI)

22.04 [13.29, 30.80]

36.1 Patients with sinus surgery

4

214

Mean Difference (IV, Fixed, 95% CI)

24.01 [9.85, 38.17]

36.2 Patients without sinus surgery

3

373

Mean Difference (IV, Fixed, 95% CI)

20.83 [9.69, 31.97]

37 Quality of life (SF36) Physical component summary Show forest plot

1

68

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐6.39, 2.39]

38 Quality of life (SF36) Mental component summary Show forest plot

1

68

Mean Difference (IV, Fixed, 95% CI)

‐5.0 [‐9.31, ‐0.69]

39 Drop‐outs Show forest plot

Other data

No numeric data

40 Adverse events Show forest plot

Other data

No numeric data

41 Overall symptom scores by source of funding Show forest plot

7

445

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.65, ‐0.27]

41.1 Industry sponsored

4

254

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.21 [‐0.46, 0.04]

41.2 Sponsored by other sources

3

191

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.11, ‐0.52]

42 Change in nasal obstruction score by source of funding Show forest plot

7

482

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.81 [‐1.01, ‐0.62]

42.1 Industry sponsored

4

259

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.05 [‐1.32, ‐0.78]

42.2 Sponsored by other sources

3

223

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.57 [‐0.84, ‐0.30]

43 Proportion of responders (reduction in polyp size) by source of funding Show forest plot

8

785

Risk Ratio (M‐H, Fixed, 95% CI)

2.09 [1.65, 2.64]

43.1 Industry sponsored

3

496

Risk Ratio (M‐H, Fixed, 95% CI)

1.71 [1.29, 2.27]

43.2 Sponsored by other sources

5

289

Risk Ratio (M‐H, Fixed, 95% CI)

3.02 [1.97, 4.61]

44 Overall symptom scores (post hoc) Show forest plot

7

445

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.91, ‐0.12]

45 Proportion of responders (overall improvement in symptom: post hoc) Show forest plot

4

234

Risk Ratio (M‐H, Random, 95% CI)

1.67 [1.27, 2.19]

46 Proportion of responders (reduction in polyp size: post hoc) Show forest plot

8

785

Risk Ratio (M‐H, Random, 95% CI)

2.23 [1.48, 3.36]

Figures and Tables -
Comparison 1. Topical steroid versus placebo
Comparison 2. Topical steroid versus no intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in endoscopy score Show forest plot

1

43

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.11, 0.91]

2 Change in CT score Show forest plot

1

43

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐1.02, 2.82]

3 Disease‐specific quality of life Show forest plot

1

43

Mean Difference (IV, Fixed, 95% CI)

5.40 [‐3.40, 14.20]

4 Drop‐outs Show forest plot

Other data

No numeric data

5 Adverse events Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 2. Topical steroid versus no intervention
Comparison 3. Low‐dose steroid versus high‐dose steroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptom scores Show forest plot

1

80

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.73, 0.15]

2 Proportion of responders (improvement in symptoms) Show forest plot

2

171

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.74, 1.21]

3 Change in polyp score Show forest plot

1

96

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.44, 0.36]

4 Proportion of responders (reduction in in polyp size) Show forest plot

1

95

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.30, 1.06]

5 Polyp recurrence after surgery Show forest plot

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.19, 1.10]

Figures and Tables -
Comparison 3. Low‐dose steroid versus high‐dose steroid