Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic outcomes and safety profile

BACKGROUND: Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into high-volume saline irrigations has been proposed to enhance the penetration of topical steroids into the paranasal sinuses. We aim to evaluate the safety and efficacy of budesonide nasal irrigation (BNI) in managing CRS. METHODOLOGY: A systematic review with meta-analysis was performed following PRISMA guidelines. Data were extracted independently from the eligible studies. In double-arm and single-arm meta-analyses, continuous outcomes were pooled using mean difference (MD) with a 95% confidence interval (CI). RESULTS: Twenty-six studies were reviewed, comprising 1464 patients. BNI had better outcomes than saline nasal irrigation (SNI) regarding Sino-Nasal Outcome Test score (SNOT-22). Lund-Kennedy Endoscopy scores (LKES) changed from baseline. Regarding safety, there was no significant difference between BNI and SNI regarding Intraocular Pressure (IOP). Single-arm analysis showed a pooled mean serum cortisol level within the normal range after BNI. CONCLUSIONS: BNI demonstrated improved SNOT-22 and LKES scores, with normal post-treatment IOP and cortisol levels, indicating a beneficial impact on CRS while maintaining safety.