The role of adjunctive therapies in the management of recurrent rhinosinusitis: a meta-analytical approach

Background Recurrent and chronic rhinosinusitis remain challenging conditions with high recurrence rates despite advances in medical and surgical management. Adjunctive therapies ranging from nasal irrigation and physiotherapy to steroid-eluting implants and dental interventions are increasingly used to enhance treatment outcomes. This meta-analysis aimed to evaluate the effectiveness of adjunctive therapies in improving clinical and radiological outcomes in patients with recurrent rhinosinusitis. Methods A comprehensive literature search was conducted across PubMed, Scopus, ScienceDirect, Google Scholar, and the Consensus Academic Database for studies published between 2015 and 2025. Eligible studies included randomized controlled trials and observational research evaluating adjunctive therapies combined with standard rhinosinusitis treatment. Data extraction and quality assessment followed PRISMA 2020 guidelines using the Cochrane Risk of Bias Tool (RoB 2) and Newcastle Ottawa Scale. Quantitative and qualitative syntheses were performed, with effect sizes expressed as mean differences and 95% confidence intervals. Results Nine studies comprising a total of 1,608 patients were included. Adjunctive therapies demonstrated a 30–50% improvement in symptom scores (SNOT-22, RSDI) and a significant reduction in recurrence rates compared to conventional treatment alone. Higher improvement rates were reported in studies evaluating steroid-eluting implants and concurrent dental interventions, which achieved over 90% post-operative success rates. Non-surgical modalities such as nasal irrigation and sinus physiotherapy also yielded meaningful symptomatic relief and improved mucociliary clearance. Heterogeneity was moderate ( I 2 50%), and no significant publication bias was detected in the funnel plot analysis. Conclusion Adjunctive therapies significantly improve symptom control, reduce recurrence, and enhance post-operative outcomes in recurrent rhinosinusitis. Integrating these modalities into standard treatment protocols supports a multimodal, patient-centered approach to disease management. Future multicentric randomized controlled trials with standardized intervention protocols are recommended to confirm and refine these findings.