From the Guidelines
Chronic sinusitis should be managed with saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief, as recommended by the clinical practice guideline update in 2015 1. For initial management, I recommend daily saline nasal irrigation using a neti pot or squeeze bottle with sterile water, along with an intranasal corticosteroid spray.
- Key points to consider:
- Saline nasal irrigation can help reduce nasal congestion and improve mucus drainage
- Topical intranasal corticosteroids can help reduce inflammation and swelling in the nasal passages
- The combination of both treatments may provide better symptom relief than either treatment alone The goal of treatment is to reduce inflammation, improve mucus drainage, and eliminate infection, thereby improving quality of life and reducing morbidity and mortality.
- Important considerations:
- Patients should be advised to avoid irritants like smoke and maintain good hydration to help manage symptoms
- A humidifier can be used in dry environments to help keep the nasal passages moist
- If symptoms persist or worsen, further evaluation and treatment may be necessary, including referral to an ENT specialist for possible endoscopic evaluation or CT imaging.
From the Research
Definition and Prevalence of Chronic Sinusitis
- Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months 2.
- It accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures 2.
Medical Therapies for Chronic Sinusitis
- Evidence supports daily high-volume saline irrigation with topical corticosteroid therapy as a first-line therapy for chronic sinusitis 2.
- A short course of systemic corticosteroids (1-3 weeks), short course of doxycycline (3 weeks), or a leukotriene antagonist may be considered in patients with nasal polyps 2.
- A prolonged course (3 months) of macrolide antibiotic may be considered for patients without polyps 2.
Treatment of Acute Bacterial Rhinosinusitis
- Antibiotic therapy should be considered in patients with prolonged or more severe symptoms of acute rhinosinusitis 3.
- Narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days to avoid the emergence and spread of antibiotic-resistant bacteria 3.
- Azithromycin has been shown to be as effective and well tolerated as amoxicillin/clavulanate in the treatment of acute sinusitis 4.
Role of Antibiotics in Chronic Sinusitis
- Despite the high prevalence of sinusitis, the cause of chronic rhinosinusitis remains elusive, and theories have come and gone throughout the years 5.
- There is no high-quality evidence that antibiotic therapy has any effect on the long-term management of chronic rhinosinusitis 5.
- No randomized placebo-controlled studies evaluating the utility of antibiotics have as yet been conducted, and there remains an urgent need for a high-quality, prospective clinical trial to determine the proper role of antibiotics in the treatment of chronic rhinosinusitis 5.