Treatment of chronic sinusitis

treatment of chronic sinusitis

Primary therapeutic option in the management of chronic rhinosinusitis (CRS) is medical, irrespective of whether polyps are present or absent (1).

• intra nasal corticosteroids (sprays or drops)
  • has been shown to be beneficial in CRS with polyps and without polyps
  • initial treatment should involve intranasal corticosteroids in conjunction with saline lavage
  • long term use (over one year) is considered safe (2)
    
    
• oral steroids
  • is effective in decreasing polyp size and nasal symptoms in the short term, but this must be balanced with the risks of oral corticosteroids (3)
    • sufficient evidence has been reported for use of a short course of oral steroids in the treatment of severe CRS with nasal polyps (2)
      
      
• saline irrigation and topical decongestants
  • a Cochrane systematic review reported that nasal saline irrigations to be beneficial and well tolerated as the sole modality of treatment in CRS
  • there is no evidence to support the use of short term decongestions in CRS
    
    
• antibiotics
  • may be considered in secondary care.
  • acute exacerbations of CRS should be treated with oral antibiotics (1,2,3)

FESS, or functional endoscopic sinus surgery is carried out by ENT surgeons for chronic rhinosinusitis with the aim of restoring ventilation and mucociliary clearance within the sinuses (2).

Reference:

1. Guilemany JM, Alobid I, Mullol J.Controversies in the treatment of chronic rhinosinusitis. Expert Rev Respir Med. 2010;4(4):463-77.
2. Ah-See KL et al. Management of chronic rhinosinusitis. BMJ. 2012;345:e7054.
3. Malaty J. Medical Management of Chronic Rhinosinusitis in Adults. Sinusitis 2016, 1(1), 76-87