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Letters |

Efficacy of Intranasal Corticosteroids for Acute Sinusitis

Peter R. Starke, MD; Badrul A. Chowdhury, MD, PhD
JAMA. 2002;287(10):1261-1262. doi:10.1001/jama.287.10.1261.
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To the Editor: Dr Dolor and colleagues1 concluded that intranasal corticosteroids are efficacious in the treatment of acute rhinosinusitis. We believe, however, that the design of their trial significantly limits the conclusions that can be drawn from it.

We believe the trial design was more like that of a large simple trial rather than a well-controlled trial. The primary efficacy variable was "time to clinical success," based solely on telephone reports of whether patients were feeling better. There were no objective measures of compliance or improvement. Direct patient symptom assessments were used as secondary end points, and interestingly, failed to show significant differences between fluticasone and placebo. The entry criteria were also problematic. Since duration of symptoms was not measured at study entry, the diagnosis of acute sinusitis could not be adequately established.2,3 The entry criterion allowing for mucosal thickening on radiographs is a poor indicator of sinusitis, particularly in the setting of chronic sinus disease and other possible comorbid conditions, such as rhinitis or upper respiratory infections, in which as many as 87% of patients have such radiographic abnormalities.4

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