What are the management options for sinusitis?

From the Guidelines

Management options for sinusitis include medical therapy, surgical intervention, and adjunctive treatments.

Medical Therapy

• Antibiotics are used to treat infectious sinusitis, with the choice of antibiotic depending on the suspected pathogens and their anticipated resistance patterns 1.
• Systemic corticosteroids may be considered for noninfectious forms of sinusitis, such as chronic hyperplastic eosinophilic rhinosinusitis 1.
• Allergy management is important for patients with underlying allergic rhinitis, as it can contribute to the development of sinusitis 1.

Surgical Intervention

• Functional endoscopic sinus surgery (FESS) is the primary surgical approach for chronic infectious sinusitis, especially when there is evidence of mechanical blockage of the ostiomeatal complex 1.
• Indications for surgical intervention include obstructing nasal polyps, recurrent or persistent infectious sinusitis despite adequate medical management, and anatomic defects that obstruct the sinus outflow tract 1.
• Open surgical procedures may be required for certain cases, such as frontal or sphenoid sinusitis, or when endoscopic approaches fail 1.

Adjunctive Treatments

• Nasal irrigation with saline may help reduce mucosal edema and enhance mucociliary clearance, although its effectiveness in sinusitis is not well established 1.
• Guaifenesin and iodine-containing compounds are sometimes used as expectorants, but their efficacy in sinusitis is not supported by clinical trials 1.
• Nonpharmacologic measures, such as humidification and nasal suction, may provide symptomatic relief for some patients, although their effectiveness is largely anecdotal 1.

From the Research

Management Options for Sinusitis

The management of sinusitis can be divided into medical and surgical interventions.

• Medical management is often sufficient for acute and subacute disease, and may include:
  • Decongestants and topical corticosteroids to open the sinus ostia and reduce inflammation 2
  • Saline irrigation to drain the congested sinuses and eliminate pathogenic bacteria 2, 3
  • Antibiotics to effectively eliminate bacteria 2, 3
  • Systemic corticosteroids to reduce inflammation, particularly in cases with nasal polyps 4, 3
  • Leukotriene antagonists to improve nasal symptoms in patients with nasal polyps 3
  • Macrolide antibiotics for patients without polyps 3
• Surgical intervention may be necessary in cases where medical management is unsuccessful, or in cases of chronic sinusitis with irreversibly diseased mucosa 4, 2, 5
  • Surgery aims to facilitate sinus drainage by widening the outflow tracks and removing anatomic obstructions to adequate drainage 2
  • Surgical options may include procedures to remove nasal polyps, correct anatomic defects, or improve sinus ventilation 6, 5

Specific Considerations for Chronic Rhinosinusitis with Nasal Polyps

• The management of chronic rhinosinusitis with nasal polyps (CRSwNP) involves treating the underlying type 2 inflammation 6
• Treatment options for CRSwNP may include:
  • Intranasal corticosteroids and oral corticosteroids to reduce inflammation 6
  • Saline solution rinses to drain the congested sinuses and eliminate pathogenic bacteria 6
  • Biologics, such as dupilumab, omalizumab, mepolizumab, and reslizumab, to target specific inflammatory pathways 6
  • Surgical intervention to remove nasal polyps and improve sinus drainage 6, 5