A systematic review and meta-analysis of the efficacy and safety of traditional Chinese medicine in the treatment of rhinosinusitis

Abstract

Background: Rhinosinusitis (RS), a common inflammatory disorder, adversely affects quality of life and can progress to serious complications without intervention. Conventional therapies, including antibiotics and corticosteroids, exhibit inherent limitations and risks. Traditional Chinese medicine (TCM), with its extensive historical use in RS management, remains understudied in contemporary evaluations. This systematic review evaluates the efficacy and safety of TCM in RS treatment, aiming to guide clinical decision-making.

Methods: A systematic search was undertaken in Chinese and English databases, such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Web of Science, and other relevant databases, to gather randomized controlled trials of TCM for patients with RS from January 2014 to February 2024. Two researchers independently curated and synthesized data from eligible literature, conducted meta-analyses with ReviewManager 5.4.1, and assessed evidence quality via GRADEPro GDT.

Results: A total of 48 articles included 4490 patients, of which 2249 were control group and 2241 were in the experimental group. Meta-analytic outcomes revealed that the integration of TCM with western medicine conventional treatment significantly enhanced the total effective rate [risk ratio=1.20, 95% confidence interval (CI) (1.17, 1.23), P < 0.05] and yielded a notable reduction in Lund-Kennedy score [mean difference (MD)=-1.32, 95% CI (-1.72, -0.93), P < 0.05], Lund-Mackay score [MD=-1.13, 95% CI (-1.27, -1.00), P < 0.05], SNOT-20 score [MD=-3.02, 95% CI (-4.34, -1.69), P < 0.05], nasal congestion Visual Analogue Scale (VAS) score [MD=-1.05, 95% CI (-1.65, -0.45), P < 0.05], runny nose VAS score [MD=-0.84, 95% CI (-1.13, -0.54), P < 0.05], headache VAS score [MD=-0.90, 95% CI (-1.45, -0.35), P < 0.05], olfactory impairment VAS score [MD=-1.43, 95% CI (-1.75, -1.11), P < 0.05], and total TCM syndrome score [standardized mean difference (SMD)=-1.78, 95% CI (-2.58, -0.97), P < 0.05]. Additionally, significant decreases were observed in levels of tumor necrosis factor-α [SMD=-2.14, 95% CI (-3.42, -0.87), P < 0.05] and interleukin-6 [SMD=-1.64, 95% CI (-2.08, -1.21), P < 0.05], with statistical significance achieved for all measured outcomes. Regarding safety considerations, an insignificant variance was observed between the 2 therapeutic approaches, with no statistically discernible difference (P > 0.05).

Conclusion: Combining TCM with western medicine in RS treatment yields superior outcomes over western medicine alone, with enhanced efficacy, reduced nasal symptoms, and lower inflammation. Rigorous multicenter RCTs are warranted to affirm these advantages and bolster the evidence for TCM in RS management.