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Management of nasal polyps with steroids: the current literature

The Cochrane Collaboration has made a major impact on our understanding of evidence-based medicine, in otolaryngology as well as in all other specialities. It is therefore perhaps not surprising that when we read a recently published review, such as that on the use of systemic steroids for the treatment of nasal polyposis, we presume that they have got it right! Indeed, the editor of Clinical Otolaryngology on reading this review immediately wrote an editorial stating that ‘it must be concluded that oral steroids for nasal polyps still requires further study’. On reading the review in detail, the literature search used only looked at papers published before April 2006 and therefore missed a significant and detailed randomised placebo-controlled trial published in May 2006. This RCT clearly demonstrated that there was a significant improvement in symptom scores, polyp size, radiological findings and quality-of-life measures with 50 mg prednisolone for 14 days when compared with placebo. One accepts that any review must draw the line somewhere. However, if during the period of finalizing the document or during its review mechanism, important new evidence appears which significantly changes the conclusions of something as important as a Cochrane review, we would question the academic logic of publishing an unmodified document. The polyp review states that a recent substantive amendment was performed in November 2006 yet the data provided from the Adelaide trial published 6 months previously was still not included at this time. We therefore conclude that all researchers, including journal editors, should still retain a healthy criticism of any paper (including Cochrane reviews) until they have reassured themselves that its findings are correct. We feel that the Cochrane review conclusions should read: that, whilst there is now clear evidence for the effectiveness of oral steroids in patients with nasal polyps, there is a need for more trials to establish both the optimal daily dose and length of treatment.