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Chronic Rhinosinusitis

Jared Freitas


  • Inflammatory syndrome of the paranasal sinuses, with objective evidence of inflammation for > 12 weeks, typically in young to middle aged adults

  • Symptoms: typically need two of the following:

  • Anterior/posterior mucopurulent nasal drainage

  • Presence of nasal fullness/congestion

  • Facial pain/pressure, sometimes accompanied by headache (most prevalent but least specific)

  • Reduction in sense of smell

  • Red flag symptoms that require more emergent evaluation by ENT or NSGY

  • Double vision

  • Proptosis

  • Ophthalmoplegia

  • Severe headache

  • Any focal neurologic deficits

  • In addition to clinical history, patients need objective evaluation with nasal endoscopy or non-contrasted CT of sinuses (gold standard imaging modality) to confirm presence of inflammation and presence of nasal polyps

  • Other conditions to consider on differential:

  • Rhinitis without sinusitis (vasomotor, gustatory, allergic, idiopathic)

  • Headache and facial pain syndromes

  • Laryngopharyngeal reflux syndrome


  • Daily sinus rinses with saline can clear sinuses of secretions, irritants and allergens

  • Utilizing daily intranasal corticosteroid sprays improve symptoms, better control when used in conjunction with sprays

  • Short courses of macrolide antibiotics less than 3 weeks duration along with short course oral corticosteroids for acute exacerbations

  • When to refer to specialist:

  • ENT: Refractory symptoms necessitating rhinoscopy to look for nasal polyps, anatomical source of obstruction, ability to get direct culture from sinuses, or for sinus surgery as treatment

  • Allergy/immunology: treatment of causal allergen or associated immunodeficiency that contributes to recurrent infections

  • 10-14 days of oral corticosteroids can also help in patients with nasal polyps shrink inflamed tissue and decrease obstructive symptoms but require ongoing nasal steroids to prevent recurrence

  • Daily antileukotriene agents and antihistamines can provide benefit in patients with an allergic component

    Smoking cessation can lead to symptom relief in CRS pts with and w/o nasal polyps

Last update: 2022-06-24 15:58:29