What are the interventions for chronic sinusitis?

From the Guidelines

Chronic sinusitis treatment should begin with medical management, prioritizing saline nasal irrigation and topical intranasal corticosteroids for symptom relief, as recommended by the most recent clinical practice guideline update 1.

Medical Management

• First-line treatment includes daily saline nasal irrigation using a neti pot or squeeze bottle with 240mL of distilled water mixed with a saline packet.
• This should be combined with intranasal corticosteroids such as fluticasone (2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) for at least 6-8 weeks.
• For patients with moderate to severe symptoms, a 10-14 day course of antibiotics may be appropriate, with options including amoxicillin-clavulanate (875/125mg twice daily), doxycycline (100mg twice daily), or levofloxacin (500mg daily) if penicillin-allergic, as suggested by earlier guidelines 1.

Surgical Interventions

• If symptoms persist despite 8-12 weeks of maximal medical therapy, referral to an otolaryngologist for evaluation for endoscopic sinus surgery is recommended.
• Functional endoscopic sinus surgery can result in significant improvement in the majority of patients, especially when combined with intensive postoperative local management and appropriate medical therapy 1.
• Patients should be counseled that chronic sinusitis often requires long-term management rather than expecting complete resolution with a single treatment course.

Key Considerations

• The role of antibiotics in chronic sinusitis is controversial, and their use should be judicious and based on clinical judgment 1.
• Systemic corticosteroids may be considered for chronic non-infectious sinusitis, and aspirin desensitization may be beneficial for aspirin-sensitive patients with sinusitis and asthma 1.
• Consultation with a specialist is recommended for patients with refractory or recurrent sinusitis, or those with underlying conditions that complicate assessment or treatment 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Chronic Sinusitis Interventions

• Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months 2
• The medical treatment, mainly topical intranasal and oral corticosteroids, constitutes the first line of therapy for chronic rhinosinusitis, including nasal polyps 3
• Long-term treatment with corticosteroid nasal spray reduces inflammation and nasal polyp size, and improves nasal symptoms such as nasal blockage, rhinorrea, and the loss of smell 3

Treatment Options

• Topical corticosteroid therapy improved overall symptom scores, improved polyp scores, and reduced polyp recurrence after surgery 2
• Systemic corticosteroids and oral doxycycline reduced polyp size compared with placebo for 3 months after treatment 2
• Leukotriene antagonists improved nasal symptoms compared with placebo in patients with nasal polyps 2
• Macrolide antibiotic for 3 months was associated with improved quality of life at a single time point compared with placebo for patients without polyps 2

Surgical Interventions

• Endoscopic sinus surgery is only recommended when medical treatment fails 3
• Surgery should be functional and involve widening the natural drainage openings of the sinuses and preserving the ciliated epithelium as much as possible 4
• In the case of nasal polyposis, surgery is more aggressive involving removal of the diseased polypous mucosa 4

Postoperative Care

• Intranasal corticosteroids should be continued postoperatively 3
• Medical treatment should be continued post sinus surgery 4
• There is no evidence to suggest that fluticasone propionate aqueous nasal spray reduces the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery 5