Chinese herbal therapy in the management of rhinosinusitis—A systematic review and meta-analysis
What this study found
Overall, Chinese herbal medicines may improve rhinosinusitis symptoms, imaging findings, and mucociliary clearance, but the certainty of evidence was low to very low. In cited comparisons, benefits favored Chinese herbal medicines for SNOT-20 (MD -4.90 [ -8.12, -1.68 ]), VAS-TNS (MD -1.40 [ -1.53, -1.27 ]), LK score (MD -0.71 [ -1.07, -0.35 ]), and CT score (MD -1.51 [ -1.98, -1.04 ]). Across adverse-event reporting in CRS trials, events were generally minor and not clearly different between groups (RR 2.06 [0.90, 4.69]; 17 vs 7 events), but reporting was incomplete. The authors concluded…
- Study & population
- Systematic review and meta-analysis of 34 randomized controlled trials including adults and children with acute or chronic rhinosinusitis.
- Intervention
- Chinese herbal medicines were evaluated as oral and/or nasal regimens, compared with placebo, conventional pharmacotherapies, or integrative regimens.
- Key limitation
- Certainty was low to very low because of risk of bias, substantial heterogeneity, small sample sizes, and frequent lack of blinding.
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Open PDFOriginal abstract
This systematic review aims to assess the effects and safety of Chinese herbal medicines (CHMs) in the management of rhinosinusitis (RS); inform clinicians of the current state of the evidence; identify the best available evidence; and suggest further directions for research. Five English and four Chinese language databases, and four clinical trial registries were searched. Eligible studies were randomised controlled trials (RCTs). Participants were diagnosed with RS based on established criteria. Test interventions were CHMs administered orally and/or nasally, excluding injections and displacement techniques. Control interventions included placebos, no additional treatment, and conventional non-invasive treatments including pharmacotherapies and/or nasal irrigation, and/or inhalations. Polyposis and post-surgical recovery were excluded. Outcomes were Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy Endoscopic score (LK), Mucociliary transport time (MTT), Mucociliary transport rate (MTR), quality of life and adverse events (AEs). Risk of bias used the Cochrane tool. Meta-analysis in Review Manager 5.4.1 used random effects for mean difference (MD) or risk ratio (RR) with 95% confidence intervals. Heterogeneity was assessed as I2. Thirty-four RCTs were included, 30 of chronic RS (CRS) and four of acute RS (ARS). These enrolled 3,752 participants. Five RCTs blinded participants. For CRS, comparisons with placebo showed greater improvements in the CHM groups for SNOT-20 and VAS-TNS (total nasal symptoms). Blinded comparisons with pharmacotherapies showed no differences between groups in the degree of improvement for SNOT-20, VAS-TNS, and LM, suggesting these CHMs had similar effects, at least in the short term. In ARS, pooled results found improved scores on VAS-TNS and LK suggesting a benefit for combining these CHMs with pharmacotherapies. Limitations included inadequacies in study design and methodological reporting, and insufficient reporting of AEs. Heterogeneity in some pooled results precluded strong conclusions. Further well-designed studies are needed to test whether the results are replicable. Systematic review registration number: PROSPERO (CRD42019119586).