Update on the management of chronic rhinosinusitis

Rachel B Cain, Devyani Lal, Rachel B Cain, Devyani Lal

Abstract

Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms persisting for greater than 12 weeks. The etiology of CRS is incompletely understood. Current understanding supports inflammation, rather than infection, as the dominant etiologic factor. CRS significantly impacts patients' quality of life and health care expenditure. There is no standard management of CRS. Treatment strategies differ based on divergent etiologies of the various CRS subclasses. Both systemic and topical agents are used. These interventions differ in CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP) and specific situations such as allergic fungal rhinosinusitis or aspirin-exacerbated respiratory disease. Antibiotics are the most commonly prescribed medication for CRS, but their role in management is not strongly supported by high-level studies. This paper provides a succinct review of the evidence supporting or refuting common therapeutic agents in the management of CRS. Novel and emerging strategies will also be discussed.

Keywords: evidence-based; review; sinusitis.

Figures

Figure 1
Figure 1
Diagnosis of CRS. Note: © 2007 Sage Publications. Reproduced with permission from Rosenfeld RM, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137(3 Suppl)S1–S31.
Figure 2
Figure 2
Factors associated with CRS. Note: © 2003 Sage Publications. Adapted with permission from Benninger M, et al. Otolaryngol Head Neck Surg. 2003;129(3 suppl):S1–S32.
Figure 3
Figure 3
CRS differentiation by inflammatory mediators. Note: Data from Van Zele T, et al. Differentiation of chronic sinus diseases by measurement of inflammatory mediators. Allergy. 2006;61:1280–1289.
Figure 4
Figure 4
Efficacy of antibiotics in CRS. Note: Data from Anon JB, et al. Otolaryngol Head Neck Surg. 2004;130(1 Suppl):1–45. Abbreviations: HD, high dose; TMP/SMX, trimethoprim-sulfamethoxazole.

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