Management of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is one of the most common reasons that persons seek medical care.1 CRS may originate from or be perpetuated by local or systemic factors predisposing to sinus ostial obstruction and infection. These factors include anatomic or inflammatory factors leading to sinus ostial narrowing, disturbances in mucociliary transport, and subsequent infection. CRS is diagnosed by various symptoms (lasting for at least 12 weeks), which include long-term nasal congestion, thick mucus production, loss of sense of smell, sinus pressure, and facial pain, as well as physical and radiographic evidence of mucosal swelling. The goal of medical management is to reduce the swelling and inflammation, especially of the ostia, and promote drainage and a more normal nasal environment. The medical treatment should include empiric broad-spectrum antibiotics with adjunctive therapy, including nasal and oral steroids, decongestants, expectorants, and saline nasal irrigation. If symptoms improve after four weeks of treatment initiation, it is recommended that the nasal steroid sprays and nasal saline irrigations should continue for at least three months. If symptoms do not improve and there is still presence of CRS signs and symptoms, the patient should be referred to an appropriate specialist for further management.