What is the best course of action for a patient with moderate sinus disease, no polyps, and mild Sinoonasal Gastroesophageal Reflux (SGS) disease?

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Last updated: March 24, 2025 • View editorial policy

From the Guidelines

For a patient with moderate sinus disease without polyps and mild Sinoonasal Gastroesophageal Reflux (SGS) disease, the best course of action is to start with intranasal corticosteroids and nasal saline lavage, and consider adding long-term macrolide therapy if symptoms persist. The patient's condition, characterized by moderate sinus disease without polyps and mild SGS, suggests an inflammatory component that can be addressed with medical management. According to the guidelines outlined in the study by 1, for moderate symptoms, initial management should include intranasal corticosteroids and nasal saline lavage.

  • Key components of the treatment plan include:
    • Intranasal corticosteroids to reduce inflammation
    • Nasal saline lavage to promote drainage and reduce symptom severity
    • Consideration of long-term macrolide therapy if the patient does not respond to initial treatment after 3 months
  • The use of long-term macrolide therapy is supported by the study, which notes that patients with moderate or severe symptoms should receive this treatment in addition to intranasal corticosteroids and nasal saline lavage if they do not improve after initial management. The patient should be reassessed after 3 months to evaluate the response to treatment, and further management, including CT evaluation and consideration of sinus surgery, should be considered if symptoms persist or worsen despite appropriate medical therapy, as suggested by 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Moderate Sinus Disease

  • For patients with moderate sinus disease, no polyps, and mild Sinoonasal Gastroesophageal Reflux (SGS) disease, treatment options may include: + Medical management with antibiotics, nasal hygiene using nasal saline washes, topical nasal corticosteroids, and decongestants 2 + Douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines 3
  • Endoscopic sinus surgery may be considered for complications, anatomical variations causing local obstruction, or patients who remain symptomatic despite medical treatment 3, 4

Efficacy of Treatment Options

  • The exhalation delivery system with fluticasone (EDS-FLU) has been shown to be safe and effective in treating chronic sinusitis with or without nasal polyps, including patients with moderate-to-severe symptoms 5
  • Oral corticosteroids following endoscopic sinus surgery for chronic rhinosinusitis without nasal polyposis may not provide additional benefits and may have adverse effects 6

Considerations for Treatment

  • The treatment approach should be individualized based on the patient's specific condition, symptoms, and medical history
  • Patients with mild to moderate sinus disease may benefit from combined treatment modalities, such as functional endoscopic sinus surgery and rhinoplasty 4

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.