Although there is evidence from randomised controlled trials that
leukotriene receptor antagonists are efficacious in chronic
rhinosinusitis there are still little data on their use in everyday real life clinical practice. We report on a pragmatic case series of 32 patients referred from primary care with uncontrolled chronic
rhinosinusitis (allergic or non-allergic) who have been treated with
montelukast in our joint medical/surgical rhinology clinic. Patients' symptoms were scored according to "
facial pain", "
headache", "
nasal blockage", "nasal discharge", "sense of smell" and "daily activity", and measurements of peak inspiratory nasal flow were made, before and after the introduction of
montelukast 10 mg/day. There were significant (p < 0.05) improvements in subjective scoring for
headache, nasal discharge & blockage, sense of smell and daily activity but not for
facial pain, when
montelukast was added along with other alterations in chronic
rhinosinusitis medication (all receiving intra-nasal
corticosteroids). Subgroup analysis of 10 patients, were the addition of
montelukast was the only change to medical
therapy, showed significant (p < 0.05) improvements in
headache, nasal discharge and blockage and their daily activity. There was no significant improvements in nasal peak inspiratory flow or spirometry. In conclusion,
montelukast may be a useful therapeutic option in addition to standard
therapy (i.e. intra-nasal
corticosteroids or anti-histamines) when treating patients with chronic
rhinosinusitis in a real life clinical setting.