CHRONIC SINUSITIS: TREATMENT OPTIONS

Chronic rhinosinusitis (CRS) is an inflammatory condition of the nose and paranasal sinuses lasting 12 weeks or longer. It does not necessarily mean there is an ongoing bacterial infection. Accurate diagnosis matters because allergic rhinitis and other conditions can cause similar symptoms.

What are the main symptoms?

Patients commonly have at least two of the following: nasal obstruction, nasal or postnasal discharge, reduced sense of smell, and facial pressure. Nasal blockage or discharge is usually one of the key symptoms. Facial pain alone is not enough to diagnose sinusitis.

Are there different types?

• CRS without nasal polyps.
• CRS with nasal polyps: benign inflammatory growths often associated with impaired smell.

Conditions such as asthma, sensitivity to aspirin or other non-steroidal anti-inflammatory drugs, some immune disorders and cystic fibrosis can affect assessment and management. Allergies may coexist but do not explain every case.

How is the diagnosis confirmed?

An ENT specialist reviews the symptoms and examines the nose, often using nasal endoscopy. Symptoms alone do not establish CRS: there should also be objective evidence of inflammation on examination or computed tomography (CT). CT is used selectively to confirm disease, assess its extent or plan surgery; it is not necessary for every patient.

What treatments are available?

• Saline nasal irrigation: helps clear secretions and relieve symptoms.
• Intranasal corticosteroids: reduce inflammation and are a mainstay of therapy, especially when polyps are present.
• Management of associated conditions: such as allergic rhinitis or asthma when relevant.
• Antibiotics: are not routine treatment for chronic inflammation; they are reserved for selected situations where a bacterial infection is clinically suspected.
• Functional endoscopic sinus surgery (FESS): may be considered when important symptoms persist despite appropriate medical treatment. Surgery aims to improve sinus drainage and access for topical medication. Ongoing therapy may still be needed because inflammation can recur.
• Biologic medicines: can be considered for selected patients with severe CRS with nasal polyps, particularly when established treatments have not provided adequate control or surgery is unsuitable.

When should you seek medical advice?

Symptoms lasting more than 12 weeks warrant ENT assessment. Seek urgent medical attention for swelling around an eye, visual changes, a severe new headache with neurological symptoms or significant deterioration.

Treatment should be tailored to the type of inflammation, objective findings, symptom burden and patient preferences.