Chronic rhinosinusitis management beyond intranasal steroids and saline solution irrigations

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease with clinical manifestations that are influenced by the presence or absence of nasal polyposis. Understanding of the current and future treatment modalities for CRS is essential in preventing exacerbation and morbidity associated with this chronic condition. Objective: The aim of this article is to review the evidence behind current medical therapies and potential new treatments for CRS. Methods: Scientific literature regarding intranasal and systemic antibiotics, intranasal systemic corticosteroids, and monoclonal antibodies as interventions for CRS with and without nasal polyps was reviewed. Results: The literature supports the use of topical or systemic glucocorticoids in patients with nasal polyps, and there appears to be a role for systemic antibiotics in the treatment of acute exacerbations of CRS with nasal polyps. The response to corticosteroids or antibiotics in the treatment of exacerbations of CRS without nasal polyps is variable. Due to the lack of appropriately designed trials, there is weak evidence for the adjunctive use of immunotherapy at this time. Monoclonal antibodies that target Immunoglobulin E and T helper cell 2 cytokines have been clinically effective in symptom reduction for some patients with CRS with nasal polyps although further studies are needed. Conclusion: Current therapies used in the treatment of CRS are discussed.