Medical therapy as the primary modality for the management of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a prevalent disease with many potential interventions including medical and surgical treatments. Because CRS is a chronic condition it is essential that therapy limits exacerbations. The purpose of this article is to show that literature supports the implementation of aggressive medical management as the mainstay of therapy for CRS. Scientific literature on the use of intranasal and systemic corticosteroids, antibiotics, nasal saline lavages, and unique therapies for individuals with CRS (both with and without nasal polyps) are reviewed. In addition, literature comparing outcomes of medical therapy versus surgical therapy are reviewed. There is ample evidence of the beneficial effects of intranasal corticosteroids (INCSs) in CRS. The literature also favors the use of systemic corticosteroids in acute exacerbations of disease in patients with nasal polyps. Although antibiotics are commonly used for acute sinusitis, there is also evidence of their potential value in CRS. The literature indicates that saline lavages show benefit in the treatment of CRS. In addition, there are promising new biological therapies on the horizon with mepoluzimab and omalizumab. At least one study comparing medical therapy versus surgical therapy for CRS found no advantage for either modality. Treatment of CRS with aggressive medical management can potentially postpone the need for surgical intervention. Clinicians should use INCSs and nasal saline lavages as maintenance therapy. Systemic corticosteroids and antibiotics should be used for acute exacerbations, especially in individuals with nasal polyps. (Allergy Asthma Proc 34:132-137, 2013; doi: 10.2500/aap.2013.34.3636)