Corticosteroid nasal irrigations vs sprays in chronic rhinosinusitis: a systematic review

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition often treated with topical corticosteroids. While nasal sprays are standard, corticosteroid nasal irrigations may improve drug delivery and outcomes. Enhanced drug delivery in CRS is important because it promotes effective deposition of medication into the paranasal sinuses, thereby strengthening anti-inflammatory effects. This systematic review and meta- analysis, conducted per PRISMA guidelines and registered in PROSPERO (CRD420251053183), evaluated randomised controlled trials comparing corticosteroid nasal irrigations to sprays in adults with CRS. Six randomised controlled trials (RCTs) involving 370 participants were included. Irrigations significantly improved health-related quality of life compared to sprays (standardized mean difference [SMD] -0.62; 95% confidence interval [CI] -1.09 to -0.15; p = 0.01), particularly in patients with nasal polyps and those without prior endoscopic sinus surgery. Significant reductions were also observed in nasal polyp scores (MD -0.58; p < 0.0001) and Lund-Mackay radiologic scores (MD -1.79; p = 0.01). No significant differences were found in nasal endoscopy scores or adverse events. In conclusion, corticosteroid nasal irrigations are a safe and effective alternative to sprays for CRS management, offering better symptom control and objective improvements. Further studies are needed to refine delivery protocols, assess the cost-effectiveness of corticosteroid nasal irrigations versus sprays, and evaluate their relative efficacy in both nonsurgical and postsurgical patients, as well as in those with or without nasal polyps.