From the Guidelines
Management of Chronic Sinusitis
Chronic sinusitis management involves a multimodal approach, including nasal saline irrigation and topical intranasal corticosteroids for symptom relief, as recommended by 1.
- Nasal saline irrigation is a key component of management, helping to clear out mucus and debris from the nasal passages.
- Topical intranasal corticosteroids, such as fluticasone or mometasone, can help reduce inflammation and swelling in the nasal passages, improving symptoms. In cases of bacterial infections, oral antibiotics such as amoxicillin-clavulanate or doxycycline may be prescribed, while oral antihistamines like loratadine or montelukast can be used to control allergic symptoms, as suggested by general medical knowledge. For patients with nasal polyps, oral corticosteroids like prednisone may be prescribed to reduce inflammation, and in some cases, surgical intervention such as functional endoscopic sinus surgery may be necessary, as indicated by 1. It is essential to maximize medical treatment for underlying rhinitis before proceeding with surgical intervention and to consider consultation with an otolaryngologist for patients with significant nasal septal deviation, obstructing nasal polyps, or recurrent symptoms despite aggressive medical management.
From the Research
Management Options for Chronic Sinusitis
- Medical therapies for chronic sinusitis aim to optimize patient quality of life and daily functioning, and minimize the risk of acute inflammatory exacerbations 2
- 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, short course of doxycycline, or a leukotriene antagonist may be considered in patients with nasal polyps 2
- A prolonged course of macrolide antibiotic may be considered for patients without polyps 2
Saline Irrigation
- Saline irrigation improved symptom scores compared with no treatment 2
- Large-volume, hypertonic nasal saline versus usual care showed improved disease-specific health-related quality of life (HRQL) at the end of three months of treatment 3
- Low-volume, nebulised saline versus intranasal corticosteroids showed no benefit of a low-volume nebulised saline spray over intranasal steroids 3
Treatment of Chronic Rhinosinusitis with Nasal Polyps
- The long-term use of intranasal corticosteroids and the short-term use of oral corticosteroids are strongly recommended 4
- Corticosteroid-eluting implants are considered an option 4
- Biologics such as dupilumab, omalizumab, mepolizumab, and reslizumab may be used in certain cases 4, 5
Adherence to Treatment
- Adherence with intranasal corticosteroids and saline irrigation may be low in chronic rhinosinusitis patients, even with management in a tertiary level, subspecialty rhinology clinic 6
- Factors associated with improved adherence include comorbid asthma, allergy, and change in 22-item Sinonasal Outcome Test score 6