Materiały źródłowe

• #1 Chronic Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441934/

  Chronic sinusitis is an inflammation of the sinus or nasal passages occurring for more than 12 weeks at a time. […] This activity outlines the evaluation and treatment of chronic sinusitis and reviews the role of the interprofessional team in managing patients with this condition. […] Summarize the treatment options for chronic sinusitis. […] The treatment should focus on modulating triggers, reducing inflammation, and eradicating the infection. […] Nasal steroids should be used with or without nasal saline irrigation. The treatment should last at least eight to 12 weeks with proper usage. […] Chronic sinusitis with polyps should be treated with topical nasal steroids. If severe or unresponsive to therapy after 12 weeks, a short course of oral steroids can be considered. […] Functional endoscopic sinus surgery can be considered for patients who fail medical management. In more complicated cases, it can serve as an adjunct to medical management. The goal of this surgery is to relieve obstructions, restore drainage and mucociliary clearance, and to ventilate the sinuses. […] If an underlying medical condition is found, then therapy should target the underlying condition. This could include surgical and medical approaches to fungal sinusitis or Intravenous immunoglobulin for immunodeficiencies. Management for both of these conditions is beyond the scope of this chapter.

• #1 Chronic sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667

  Treatments for chronic sinusitis include: […] Nasal corticosteroids. These nasal sprays help prevent and treat swelling. Some are available without a prescription. Examples include fluticasone (Flonase Allergy Relief, Xhance), budesonide (Rhinocort Allergy), mometasone (Nasonex 24HR Allergy) and beclomethasone (Beconase AQ, Qnasl, others). […] Saline nasal rinses. Use a specially designed squeeze bottle (NeilMed Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear sinuses. Saline nasal sprays also are available. […] Corticosteroids shots or pills. These medicines ease severe sinusitis, especially for those who have nasal polyps. The shots and pills can cause serious side effects when used long term. So they’re used only to treat severe symptoms. […] Allergy medicines. Using allergy medicines might lessen allergy symptoms of sinusitis caused by allergies.

• #1 Chronic Sinusitis and Nasal Polyps | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/ear-nose-throat/sinus/chronic-sinusitis-nasal-polyps

  Chronic sinusitis with polyps is an inflammation of the sinuses that lasts more than 12 weeks and is associated with nasal polyps. […] The treatment for polyps depends on what is causing them, so it is very important to get a thorough evaluation of the polyps in order to obtain the best treatment. Before surgery, we may want to try: […] Steroid sprays are prescribed for most types of nasal polyps, particularly mild polyps caused by allergic rhinitis (allergies to cats, dust, molds, pollens, trees, grasses and/or molds). They are also used for patients with medium and large polyps. Steroid sprays are helpful in shrinking polyps or slowing their natural growth. […] Steroid pills will cause a dramatic shrinkage of the polyps, but the effect is usually temporary a few days or a few weeks. While the fluid in the polyp is dramatically reduced, the inflammatory cells and tissue remain; after stopping the steroids, the water returns to the polyps and they often return to their original size, if nothing else is done.

• #1 Chronic Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1015/p500.html

  The goals of treatment in patients with chronic rhinosinusitis are to manage symptoms and improve or maintain quality of life. Treatment is directed at enhancing mucociliary clearance, improving sinus drainage/outflow, eradicating local infection and inflammation, and improving access for topical medications. Treatment consists of medical management, and endoscopic sinus surgery if appropriate medical management is unsuccessful. […] Multiple studies have demonstrated that at least daily saline irrigations reduce symptoms and improve quality of life in patients with chronic rhinosinusitis. Low-pressure, high-volume (240 mL) saline irrigation may significantly reduce sinonasal symptoms in 50% of patients and is superior to nasal saline spray in reducing sinonasal symptoms. […] Many RCTs have demonstrated that intranasal corticosteroid sprays improve sinonasal symptoms and endoscopic findings in chronic rhinosinusitis. […] Endoscopic sinus surgery is an effective treatment of chronic rhinosinusitis when appropriate medical therapy is ineffective. The goals of endoscopic sinus surgery in the treatment of chronic rhinosinusitis are to provide ventilation and drainage of the paranasal sinuses and to enlarge the paranasal sinuses to create greater access for topical medications.

• #1 Patient education: Chronic rhinosinusitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics/print

  Potential treatments for chronic rhinosinusitis include: Lifestyle modifications — People with chronic rhinosinusitis who smoke cigarettes should stop. […] Daily nasal saline washing — Most people with chronic rhinosinusitis find that washing/irrigating their nasal passages daily with saline (salt water) helps reduce symptoms. […] Antiinflammatory steroids — Because all forms of chronic rhinosinusitis involve some degree of inflammation (ie, irritation and swelling), most people with the condition need medications to reduce inflammation. […] Sprays and rinses — Your health care provider will probably ask you to try a steroid nasal spray initially, as sprays are easy to use. […] Steroid pills — In some cases, your health care provider will recommend taking steroid pills by mouth (orally). The most commonly used oral steroid is prednisone.

• #1 Sinusitis: Learn More – Treating chronic sinusitis – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279484/

  Chronic sinusitis can be unpleasant and affect your quality of life. But certain medications can help to relieve the symptoms especially steroid nasal sprays. Surgery is sometimes an option too. […] Steroid nasal sprays reduce swelling in the sinuses. If there are nasal polyps, treatment with a steroid nasal spray can shrink them. […] Although steroid tablets are effective too, they are generally only used in rare cases because of their side effects. They should not be used for more than three weeks. […] Severe bacterial sinusitis can in rare cases lead to complications. That may happen if the infection spreads beyond the sinuses. Then you quickly have to take antibiotics. […] Decongestant nose drops or nasal sprays aim to soothe the mucous membranes and reduce swelling. […] As well as medication, you can use saline (salt water) solutions to reduce swelling in the mucous membranes and to help loosen the mucus (snot).

• #1 Chronic Sinusitis Treatment & Management: Approach Considerations, Control of Predisposing Factors, Symptomatic Treatment

  https://emedicine.medscape.com/article/232791-treatment

  The American Academy of Otolaryngology-Head and Neck Surgery Foundation has updated its clinical practice guidelines for the treatment of adult sinusitis. […] The recommendations to clinicians are as follows: […] Recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptomatic relief of CRS. […] Initial oral steroid therapy followed by topical steroid therapy was found to be more effective than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients with CRS with at least moderate nasal polyposis. […] In June 2019, the FDA approved dupilumab for the treatment of inadequately controlled severe chronic rhinosinusitis with nasal polyps (CRSwNP) in adults. […] In individuals with CRSwNP, the major intervention is to relieve the obstruction to sinus drainage by reducing or eliminating the polyp.

• #1 Chronic sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667

  Aspirin desensitization treatment. This is for people who react to aspirin and the reaction causes sinusitis and nasal polyps. Under medical supervision, people receive larger and larger doses of aspirin to increase their ability to take it. […] Medicine to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, a shot of dupilumab (Dupixent), omalizumab (Xolair) or mepolizumab (Nucala) might reduce the size of the nasal polyps and lessen stuffiness. […] Antibiotics are sometimes needed to treat sinusitis caused by bacteria. A possible bacterial infection might need to be treated with an antibiotic and sometimes with other medicines. […] For sinusitis caused or made worse by allergies, allergy shots might help. This is known as immunotherapy. […] For chronic sinusitis that doesn’t clear up with treatment, endoscopic sinus surgery might be an option. In this procedure, a health care provider uses a thin, flexible tube with an attached light, called an endoscope, and tiny cutting tools to remove the tissue that’s causing the problem.

• #1 Patient education: Chronic rhinosinusitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics/print

  Antibiotics — Although chronic rhinosinusitis is often caused by inflammation rather than infection, sinus infections can develop and aggravate symptoms. As a result, some people need to take antibiotics. […] Surgery — Although health care providers usually attempt to get the symptoms of chronic rhinosinusitis under control with medication first, some people need surgery to reopen the sinus drainage pathways and remove trapped mucus or polyps.

• #1 UC Davis Health | Department of Otolaryngology | Treatment of Chronic Sinusitis

  https://health.ucdavis.edu/otolaryngology/specialty/sinus-center/treatment-chronic-sinusitis.html

  For patients with underlying inflammation of chronic sinusitis, however, the nose and sinuses may take longer to respond. In these patients, 3-4 weeks of antibiotics, or even longer, may be necessary to treat an acute exacerbation of their chronic sinusitis. Most patients with chronic sinusitis have previously been on many short courses of antibiotics, usually insufficient to stamp out the bacteria in a chronically inflamed sinus. […] In patients who do not respond well to antibiotics, a culture can be quite helpful. In this circumstance a sample of the bacteria is sent to the laboratory for identification and other testing. […] Nasal steroid sprays […] Antibiotics […] Saline irrigations […] Antihistamines […] Decongestants […] Mucolytics […] Oral Steroids.

• #1 Chronic Sinusitis Medication: Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Tetracyclines, Anti-Infectives, Decongestants, Corticosteroids, Nasal sprays, Mast cell stabilizers, Expectorants, Leukotriene Receptor Antagonist, Interleukin Inhibi

  https://emedicine.medscape.com/article/232791-medication

  The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Agents used in the treatment of chronic sinusitis include antibiotics, decongestants, nasal saline sprays, mast cell stabilizers, and expectorants. […] In June 2019, the FDA approved dupilumab for treatment of inadequately controlled severe chronic rhinosinusitis with nasal polyps (CRSwNP) in adults. Approval was supported by phase 3 clinical trials (eg, SINUS-24, SINUS-52) demonstrating significant improvement nasal congestion/obstruction, nasal polyps score, sinus opacification, and improvement in smell when added to standard-of-care mometasone furoate nasal spray compared with placebo plus mometasone. […] Criteria of antibiotic selection for the treatment of chronic sinusitis include the following: Culture-directed when possible, Knowledge of changing antimicrobial resistance in a community, History of medication allergy, especially the sulfa drugs and penicillins, Adverse effect profile of the medication, Cost of the medication and the economic status of the patient, Other factors that affect compliance, such as dosing and formulation.

• #1 Chronic Sinusitis Medication: Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Tetracyclines, Anti-Infectives, Decongestants, Corticosteroids, Nasal sprays, Mast cell stabilizers, Expectorants, Leukotriene Receptor Antagonist, Interleukin Inhibi

  https://emedicine.medscape.com/article/232791-medication

  Ideally, direct antibiotics against the organism obtained from endoscopic sampling and based on microbial sensitivity testing. If the patient is ill, empiric antimicrobial therapy may be indicated, which should be comprehensive and cover all likely pathogens in the context of the clinical setting. Duration of antibiotics is not well established. An initial 2- to 4-week trial of antibiotics may be reasonable. A longer duration (up to 12 mo) may be needed in some cases. After surgical management for uncomplicated chronic sinusitis is completed, antibiotics are of unclear benefit. Invasion of bone or deep structures may require a prolonged antibiotic course. […] Currently, first-line antibiotics for patients with chronic sinusitis include amoxicillin-clavulanate, second-generation cephalosporins, and erythromycin-sulfasoxazole.

• #1 Chronic Sinusitis Medication: Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Tetracyclines, Anti-Infectives, Decongestants, Corticosteroids, Nasal sprays, Mast cell stabilizers, Expectorants, Leukotriene Receptor Antagonist, Interleukin Inhibi

  https://emedicine.medscape.com/article/232791-medication

  Antimicrobials effective against S aureus may also be needed. Whenever methicillin-resistant S aureus (MRSA) is present, vancomycin or linezolid should be administered. […] Antibiotics can also be administered topically with or without a nebulizer. This mode of administration is used in patients who have had prior sinus surgery. […] These agents are particularly effective for chronic sinusitis associated with allergic rhinitis, nasal polyps, and rhinitis medicamentosa. Corticosteroids can be administered in the form of nasal sprays or solutions. Topical steroids along with systemic antibiotics are now the key components of the medical armamentarium in the management of chronic sinusitis. […] Inhibition of interleukins 4 and 13 with dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) has shown to decrease polyp burden and improve symptoms. […] Dupilumab, (Dupixent), is a monoclonal antibody blocking interleukin 4 and interleukin 13, used for allergic diseases such as eczema, asthma and nasal polyps which result in chronic sinusitis.

• #1 Sinus Infection (Sinusitis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17701-sinusitis

  Chronic sinusitis symptoms last at least 12 weeks. Bacteria are usually the cause. […] Providers treat chronic sinusitis by focusing on the underlying condition. Treatments can include: Intranasal steroid sprays, Topical antihistamine sprays or oral pills, Leukotriene antagonists, like montelukast, Surgery to treat structural issues, polyps or fungal infections. […] You might find acupressure, acupuncture or facial massage helpful in reducing symptoms of sinusitis, including draining, pressure and pain. Ask a provider if these therapies might help in your specific case. […] Getting rid of chronic sinusitis isnt easy. Cleveland Clinics experts are here to treat your lingering pain, congestion and drainage.

• #1 Chronic Sinusitis (in Adults) – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-sinusitis-in-adults-a-to-z

  If you think you have sinusitis, you can try some things at home first to help reduce swelling and open blocked sinuses. Inhaling steam and using nasal saline spray washes often helps. Decongestants, by mouth or nasal spray, are available without a prescription and can help to relieve the pressure. To control the pain, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others). […] Because chronic sinusitis often is caused by inflammation related to allergies, identifying, treating and preventing your allergies helps to relieve the sinusitis. Allergy medications include antihistamines, decongestants, leukotriene inhibitors and anti-inflammatory medications. […] Corticosteroid nasal sprays also can relieve nasal swelling and sinus inflammation. If these sprays don’t help, you may need a trial of oral steroids, such as prednisone. If there is evidence of active bacterial infection, you may need to take a course of antibiotics.

• #1 Chronic Sinusitis and Nasal Polyps: Diagnosis and Treatment | Northwestern Medicine

  https://www.nm.org/healthbeat/medical-advances/chronic-sinusitis-and-nasal-polyps

  Chronic sinusitis occurs when inflammation in your sinuses (air-filled pockets in your face) causes symptoms. […] If you have both nasal polyps and chronic rhinosinusitis, you may be a candidate for one of three injectable medications approved by the U.S. Food and Drug Administration: omalizumab, mepolizumab or dupilumab. […] Oral corticosteroids and nasal corticosteroid sprays are often used to treat nasal polyps. […] Surgical procedures can also help you breathe easier. […] Options may include: Traditional sinus surgery, which involves removing diseased sinus tissue and improving sinus drainage. […] Minimally invasive balloon sinuplasty, which expands the natural drainage openings of the passages. […] A sinus implant, which can be an option for adults who have previously had endoscopic sinus surgery. […] With so many options, it’s important to have a collaborative team to develop a treatment plan that meets your individual needs, says Dr. Kern.

• #1 Sinusitis: Learn More – Treating chronic sinusitis – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279484/

  Ibuprofen, acetaminophen (paracetamol) and acetylsalicylic acid (the drug in e.g. Aspirin) can relieve the pain, but won’t make the sinusitis go away any faster. […] Dupilumab, omalizumab and mepolizumab have been approved in Germany for use in adults who have severe chronic sinusitis with nasal polyps. These biologics are used together with steroid medication. […] If the symptoms are severe and don’t improve enough or for long enough from using medication alone, some people decide to have surgery. […] The procedure most commonly used to treat chronic sinusitis is called functional endoscopic sinus surgery (FESS). […] Surgery is considered if steroid sprays and other treatments don’t relieve the symptoms enough or the inflammation spreads, increasing the risk of complications. […] FESS is also supposed to increase the effectiveness of medications or saline solutions by making it easier for them to reach the sinuses. […] This involves inserting a catheter through the nose and slowly inflating a small balloon at the opening of the sinuses.

• #1 Relieve Your Chronic Sinusitis with Immunotherapy Treatment

  https://drmatorin.com/relieve-your-chronic-sinusitis-with-immunotherapy-treatment/

  Relieve Your Chronic Sinusitis with Immunotherapy Treatment […] For chronic sinusitis sufferers who are going through over-the-counter allergy medications like water and want to finally find long-lasting relief, immunotherapy treatment might be right for you. […] There are a couple of treatments for chronic sinusitis, such as Immunotherapy and Ballon Sinuplasty (among others). The doctor will give you the best alternative according to a previous diagnosis. […] Immunotherapy treatment is the fancy name for an allergy shot. It is a long-term treatment option for reducing or eliminating symptoms for many allergy patients. […] In contrast, allergy shots modify your immune system’s reaction to allergens. As a result, they treat the root cause of your chronic sinusitis. […] Another benefit of allergy shots is that they are custom-made just for you.

• #1 Relieve Your Chronic Sinusitis with Immunotherapy Treatment

  https://drmatorin.com/relieve-your-chronic-sinusitis-with-immunotherapy-treatment/

  With customized immunotherapy shots, you won’t have to guess whether or not your allergy shot will work. You can rest assured your customized vial has enough of what you need to get relief – every time. […] Instead, with immunotherapy treatment, visit the clinic once every 10 to 11 weeks for a new custom vial. Save time and money. It’s a win-win! […] A study from 2004 found that patients who underwent immunotherapy treatment had 72% fewer days off from work or school. […] Finally, immunotherapy treatment lets people with chronic sinusitis experience long-term relief. […] Thankfully, you don’t have to sacrifice other aspects of your health for long-term sinus relief. Immunotherapy is designed specifically as a long-term solution to reduce or even eliminate your worst allergy symptoms. […] You may want to consider seeking out allergy shots if you’re experiencing chronic sinusitis symptoms.

• #1 Chronic Sinusitis: Symptoms, Causes, Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/chronic-sinusitis

  There are several choices of treatment for chronic sinusitis including medications, immunotherapy, and surgery. […] The purpose of nasal corticosteroids is to prevent and treat inflammation including fluticasone, triamcinolone, budesonide, and mometasone. […] Saline nasal irrigation with solutions or nasal sprays washes away irritants and allergies as well as reduces drainage. […] These medications are used to relieve inflammation in severe sinusitis specifically in the patients with nasal polyps. However, because using corticosteroids in the long term may lead to some serious side effects, these kinds of medications are used only in the patients who have severe symptoms. […] Sensitivity of aspirin is one of the factors causing chronic sinusitis. Larger doses of aspirin are sometimes given in order to increase your tolerance.

• #1

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  […] […] Surgery […] If medical therapy fails or if complications are suspected, an otolaryngology consultation is warranted. This may begin with a nasal endoscopy for better visualization of the nasal cavity and ostiomeatal complex. The otolaryngologist can also perform endoscopically guided sinus culture. If surgical therapy is being contemplated, newer techniques of functional endoscopic sinus surgery are performed to clear sinuses of chronic infection, inflammation, and polyps. This may be combined with somnoturboplasty (i.e., shrinkage of the turbinate using radiofrequency waves). Endoscopic sinus surgery is commonly performed on an outpatient basis using local anesthesia and has less morbidity than traditional open surgery for chronic sinus disease. Special consideration should be given to patients who have chronic sinusitis and nasal polyps and who also have aspirin-induced asthma. This is commonly referred to as the aspirin triad of aspirin sensitivity, asthma, and polyposis. Although most of these patients undergo sinus surgery and polypectomy, additional therapy with nasal steroids, leukotriene modifiers, and aspirin desensitization, followed by 650 mg aspirin twice daily, should be considered.

• #1 Chronic Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1015/p500.html

  Chronic rhinosinusitis is defined by the presence of at least two out of four cardinal symptoms (i.e., facial pain/pressure, hyposmia/anosmia, nasal drainage, and nasal obstruction) for at least 12 consecutive weeks, in addition to objective evidence. Treatment is directed at enhancing mucociliary clearance, improving sinus drainage/outflow, eradicating local infection and inflammation, and improving access for topical medications. First-line treatment is nasal saline irrigation and intranasal corticosteroid sprays. […] If medical management fails, endoscopic sinus surgery may be effective. Patients not responding to first-line medical therapy should be referred to an otolaryngologist, and selected patients with a history suggestive of other comorbidities (e.g., vasculitides, granulomatous diseases, cystic fibrosis, immunodeficiency) may also benefit from referral to an allergist or pulmonologist.

• #1 Chronic Sinusitis Treatment & Management: Approach Considerations, Control of Predisposing Factors, Symptomatic Treatment

  https://emedicine.medscape.com/article/232791-treatment

  Biologics for CRSwNP modulate the type 2 inflammatory pathway. […] Daily saline irrigation with topical cortical steroid therapy is to be considered prime therapy for chronic sinusitis. […] In patients with nasal polyposis, systemic corticosteroids (3 weeks), doxycycline (3 weeks), and/or a leukotriene antagonist should be considered. […] Probiotic therapies may offer clinical benefit in CRS. […] Surgical care is used as an adjunct to medical treatment in some cases. […] Recent advances in endoscopic technology and a better understanding of the importance of the ostiomeatal complex in the pathophysiology of sinusitis have led to the establishment of functional endoscopic sinus surgery (FESS) as the surgical procedure of choice for the treatment of chronic sinusitis. […] Balloon sinuplasty is an option in the treatment of sinusitis that has failed to respond to appropriate medical therapy. […] The preferred treatment for chronic fungal sinusitis is surgical debridement. […] Some literature has suggested that topical antifungals may have a role in the treatment of CRS; however, this treatment remains controversial, and other studies have not supported this approach.

• #1 Surgical Treatment for Chronic Sinusitis | NYU Langone Health

  https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

  At NYU Langone, doctors recommend sinus surgery only if over-the-counter or prescription medications and other therapies fail to relieve symptoms of chronic sinusitis. […] Our surgeons can correct structural problems within the nasal passages and sinuses and remove polyps or other tissue blocking the nasal passages. Clearing the nasal and sinus passages allows mucus to drain normally, reducing facial pressure and pain, restoring your sense of smell, and making it easier to breathe. […] Sinus surgery using a nasal endoscope is the most commonly recommended procedure for people with chronic sinusitis. […] Endoscopic sinus surgery typically takes about two hours and does not require an overnight hospital stay. […] Because of this, surgeons at NYU Langone may suggest image-guided or computer-assisted endoscopic sinus surgery to allow for a more safe and thorough procedure.

• #1 Chronic Sinusitis

  https://www.laent.com/procedures/nose-sinus/chronic-sinusitis/

  Chronic sinusitis is caused when the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. This constant inflammation is often due to allergies, chronic bacterial infection or nasal polyps. […] Surgery of the nose and sinuses has experienced remarkable progress in the past 50 years, benefiting from improved imaging, better understanding of anatomy, and image-guided surgical techniques. FESS is the primary approach today for treating chronic sinusitis that doesn’t respond to other medical treatment. […] Improvement of symptoms for patients with chronic sinusitis has around a 90% success rate, and FESS has a much lower complication rate than conventional sinus surgery. […] An alternative to traditional endoscopic procedures, balloon sinuplasty, or BSP, provides a less invasive treatment with fast recovery and little patient impact. […] A study of patients receiving a balloon sinuplasty to treat chronic sinusitis reported significant symptom reduction two years post-procedure.

• #1 Surgical Treatment for Chronic Sinusitis | NYU Langone Health

  https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

  Computer guidance allows surgeons to precisely identify and remove tissue or bone while preserving surrounding structures. […] Balloon sinuplasty allows the surgeon to dilate a blocked sinus, creating open space, which allows the sinus to drain normally. […] If the sinus blockage is not responsive to balloon sinuplasty, or if symptoms of chronic sinusitis are severe, doctors may choose to perform this procedure in combination with endoscopic or image-guided sinus surgery. […] After surgery, NYU Langone doctors schedule several follow-up appointments in order to monitor your recovery. Our doctors also provide continued support to ensure that symptoms of chronic sinusitis are effectively managed.

• #1 Acute vs Chronic Sinusitis: Treatment Options

  https://www.houstonent.com/blog/acute-vs-chronic-sinusitis-treatment-options

  Antibiotics: This type of medication is sometimes needed when you have chronic sinusitis with associated bacterial infection. If no underlying infection can be ruled out, you’ll be prescribed antibiotics with other medicines. […] Balloon sinuplasty surgery: This type of surgery is safe and effective and minimally invasive. It’s used by qualified doctors for treating patients with chronic sinusitis (or if your acute sinusitis is recurrent) and you haven’t responded to any other therapies and medications. Studies have shown this surgery to be durable, effective, and last for up to 2 years after your procedure. […] Your doctor will sit down with you and discuss a treatment plan that is most effective for your individual case. They might start you off with self-care methods and see if this can effectively treat your sinusitis. If not, you may require stronger types of medication and therapy. Either way, you dont have to suffer from the uncomfortable symptoms of sinusitis.

• #1 Chronic Sinusitis: Treatment, Symptoms, and Causes

  https://www.healthline.com/health/chronic-sinusitis

  Endoscopic sinus surgery: Your doctor inserts a thin tube with a light and a camera into your sinuses to see if polyps, mucus, or other tissue is blocking your sinuses. Your doctor may then remove the blockage. In some cases, your doctor may increase the space in your sinuses to help you breathe. […] Deviated septum surgery (septoplasty) or nose surgery (rhinoplasty): Your doctor reshapes the wall between your nostrils or the tissue of your nose to straighten it out or expand it. This can help you breathe more easily out of both nostrils.

• #1 Sinusitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000647.htm

  Chronic sinusitis is when the symptoms and swelling of the sinuses is present for longer than 3 months. It may be caused by bacteria or a fungus. […] Chronic sinusitis should be treated for 3 to 4 weeks. […] Other treatments for sinusitis include: Allergy shots (immunotherapy) to help prevent the disease from returning, avoiding allergy triggers, nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies, oral corticosteroids. […] Surgery to enlarge the sinus opening and drain the sinuses may also be needed. You may consider this procedure if your symptoms do not go away after 3 months of treatment. […] Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

• #1 Sinusitis Treatment | Bay Area Sinus Doctor Jerome Hester, MD ENT

  https://www.drhesterent.com/sinusitis-treatment/

  If the previous medications are not successful, antibiotics may be added. […] Additionally, if repeated or continuous use is not successful, this is typically a sign of a more complicated case that requires evaluation by a sinus specialist. Oral steroids (prednisone) can be added to decrease inflammation if the antibiotics are not effective. […] In chronic situations, the previously mentioned medications can all have a role. However, it is best to have tests such as a CT scan performed in these cases to truly understand what the cause of the chronic condition. […] The successful treatment of allergies can play a significant role in improving some sinusitis symptoms. […] Turbinates are normal structures that extend from the lateral wall of the nasal cavity like a shelf. […] Although complete removal can cause serious side effects, many times these structures become abnormally enlarged.

• #1 Sinusitis

  https://www.racgp.org.au/afp/2016/june/sinusitis

  In the event that appropriate medical therapy fails, patients should be referred to an otorhinolaryngologist for consideration of surgical management. The current surgical approach to CRS is functional endoscopic sinus surgery (FESS). FESS involves endoscopic removal of polyposis when present, and ventilation of sinus cells. Major complications are rare, but include damage to extraocular muscles, loss of vision, cerebrospinal fluid leak and meningitis. […] It is important for patients to be aware that CRS is an inflammatory condition of the mucosa, and that as such, sinus surgery is not a cure for their condition; rather, it is an attempt to allow better symptom control. Ongoing use of topical steroids and nasal rinses are often required postoperatively to control mucosal inflammation. This is especially true for those patients with polyposis, with 60% requiring a further polypectomy within five years.

• #1 Sinusitis Treatment New Jersey & PA | Becker ENT & Allergy

  https://www.beckerentandallergy.com/ent/sinusitis

  In some cases, patients may still need medications (ie-nasal steroid sprays, nasal anti-histamines, saline irrigations, etc) to treat and manage the underlying disease process (sinusitis); however, unlike before surgery the medications are typically more effective since the sinuses will be open and accessible to topical medicines. […] Your physician will typically look for the least invasive means to help you manage your sinusitis symptoms and decrease the impact of sinus inflammation on your quality of life. […] In cases where medications do not provide sufficient, sustainable, long-term relief, and where there is felt to be a structural component to the sinus blockage, surgery may be considered. Opening the small sinus ostia is performed as a means to restore natural sinus drainage and to allow the sinus lining to return to its normal, healthy state.

• #1 Patient education: Chronic rhinosinusitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics/print

  Chronic rhinosinusitis cannot be cured in most cases, although treatment can significantly reduce symptoms and improve quality of life. The best approach to treatment involves identifying the factors that contribute to chronic rhinosinusitis in each specific person and correcting these factors to the degree possible. Most people are treated primarily with medications, although many also need surgery. Even after surgery, medications to control inflammation are usually needed indefinitely. […] Unfortunately, chronic rhinosinusitis cannot be cured in most cases, but the symptoms can be managed so that they are not so burdensome. People with chronic rhinosinusitis usually need lifelong treatment to keep the symptoms under control. Several treatment options are available, but not all treatments are appropriate for all people. Different combinations of these treatments will be recommended depending on the type of chronic rhinosinusitis you have, the severity of your symptoms, and if other conditions are also causing symptoms (such as allergies or asthma).

• #1 Medical Management of Sinusitis | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/medical-management-sinusitis

  Chronic Sinusitis […] Antibiotic selection in cases of chronic sinusitis will depend upon previous antibiotics used and previous duration of treatment. In patients who have had little by way of previous treatment, amoxicillin is employed for three weeks in doses of 500 mg TID in patients not allergic to penicillin. […] For patients who have received previous courses of treatment, a culture-directed antibiotic is employed for three to four weeks. The culture is taken from the middle meati using Calgi-Swabs under endoscopic guidance. When no material is readily culturable, an empiric choice of broad-spectrum antibiotic is made. Antibiotics commonly used are: Clarithromycin, 500mg, BID; Clindamycin, 300mg, QID; Levofloxacin, 500 mg, QD; Amoxicillin/clavulanate potassium, 875mg, BID. […] Patients with chronic sinusitis usually benefit from a steroid nasal spray. Many will also benefit from nasal saline irrigations. The „recipe” for the irrigations and patient instructions are listed in Nursing Protocols (Home Care Instructions, Nasal Irrigation). […] Patients with symptoms suggestive of allergies are referred for an evaluation by an allergist. They may benefit from antihistamine use, sodium cromoglycate (Cromolyn) nasal spray, testing for specific allergens, and eventual immunotherapy. […] Patients with severe, recurrent, or unusual infections may be immunocompromised and benefit from an immune-deficiency workup. Occasionally patients, particularly in the younger age groups, may first be diagnosed with cystic fibrosis as a result of paranasal sinus manifestations with polyposis. When cystic fibrosis is suspected, a sweat-chloride test and genetic analysis can be performed. […] Surgery is not considered in patients with chronic sinusitis until they have failed two prolonged courses of broad-spectrum antibiotics. In these circumstances, the patient must feel that their symptoms are sufficiently bothersome to warrant surgery. A full and frank discussion of the risks, benefits, and alternatives to operative intervention is carried out.

• #1 Perspectives in Therapy of Chronic Rhinosinusitis

  https://www.mdpi.com/2075-4418/12/10/2301

  Dupilumab is a fully HuMAb that inhibits type 2 inflammation through blocking the shared receptor component for IL-4 and IL-13—IL-4 receptor α chain (IL-4Rα), resulting in blocking those two cytokine signalling pathways through the STAT6 pathway. Currently, dupilumab is indicated as being added to the daily standard of care in adult patients with uncontrolled CRSwNP and is also used in other conditions characterized by local and systemic eosinophilia such as atopic dermatitis and asthma. Dupilumab added to INCS therapy reduced severity of symptoms, endoscopic polyp size, sinus opacification, markers of Th2 inflammation and, in patients with coexisting asthma, improved pulmonary function (forced expiratory volume in one second) and control of asthma symptoms. […] Various biologics have been confirmed to be effective as add-on treatments to INCS and those drugs are particularly important in the therapy of patients with recurrent polyps, resistant to conventional methods of treatment. Hopefully, effective therapeutic solutions for every endotype will be widely available very soon.

• #1

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  […] […] Summary […] The antibiotics of choice for chronic sinusitis include agents that cover organisms causing acute sinusitis but that also cover Staphylococcus species and anaerobes. Medical therapy for chronic sinusitis should include a topical intranasal steroid to address the strong inflammatory component of this disease. Allergy consultation should be considered in any patient with recurrent acute or chronic sinusitis to rule out allergy as a contributing factor for sinusitis. If medical therapy fails or if complications are suspected, an otolaryngology consultation is warranted.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-sinusitis.aspx

  The nasal passages may be irrigated with normal saline. This is called nasal saline irrigation. […] These are usually needed in patients who have a bacterial or fungal infection of the sinuses. Antibiotics may also be needed in patients with viral infections and inflammations in case there are secondary bacterial infections. […] In case of bacterial sinusitis, 70% of patients improve within 2 weeks without antibiotics and around 85% improve with necessary antibiotics. […] If allergies are the cause of the recurrent sinusitis, anti-allergy medications like antihistamines may be prescribed. […] Patients with severe inflammation of the nasal and sinus mucosal membranes may need prescription nasal sprays with corticosteroids like Fluticasone, Betamethasone or Beclomethasone. […] Those who do not respond to medications or have long term sinusitis with anatomical problems like nasal polyps, deviated nasal septum, nasal bony spurs or large adenoids, may need surgical therapy. […] Patients are advised to avoid smoking, air pollutants, avoid allergenic triggers like pet hair, dust mites etc. to prevent onset of sinusitis.

• #1 Sinus Infection (Sinusitis): Symptoms, Causes, Duration, and Treatment

  https://www.webmd.com/allergies/sinusitis-and-sinus-infection

  Sinusitis home remedies […] While medicines can help, many cases of sinusitis go away on their own without any medical treatment. If you often get the condition, many of these same approaches will help you prevent it, too. […] Humidity. Use a humidifier in rooms where you spend a lot of time. Follow the instructions for regular cleaning. […] Breathe in steam vapors. You can either run the shower and sit in the bathroom, or breathe in steam from a bowl of warm (but not too hot) water. The steam vapors ease congested and swollen nasal passages. […] Use warm heat. Put a warm, wet towel on your face. It can take off some of the pressure. […] Sinusitis nasal washing. Also known as nasal irrigation, this is an at-home treatment that will flush out your sinuses and temporarily relieve your symptoms. One common type that you may have heard of is a neti pot. Its a simple remedy but does need to be done with care. Heres how it works. You squeeze or pour a saline solution — you can buy one at your local pharmacy — into your nostrils. That solution will thin your mucus and allow it to drain. […] Drink lots of fluids. They’ll help thin the mucus, which reduces the blockage in your sinuses. Cut down on alcohol, which makes the swelling worse. […] Rest. When you’ve got a sinus infection, take it easier than normal. Get plenty of sleep, and give your body a chance to recover.

• #1

  https://www.allinahealth.org/healthysetgo/heal/ten-home-remedies-to-relieve-sinus-pain-and-pressure

  Ease sinus pain and pressure with nasal irrigation, steam inhalation and humidifiers. […] Decongestants and antihistamines, along with rest, can speed recovery. […] Decongestant sprays keep your nasal passages moist, unblock congestion and treat inflammation. Likewise, oral decongestants, antihistamines and pain relievers can reduce pain and pressure. […] Rest helps your body fight infection and speed up recovery. […] Use a humidifier or vaporizer in your room while you sleep to add moisture to the air and help reduce congestion. […] Vitamin C may help fight off sinus infection faster, reduce sinus inflammation and relieve the duration of a sinus infection or cold symptoms. […] If your sinus symptoms are not getting better with at-home treatments you should see a doctor for treatment. […] If you have frequent or reoccurring sinus infections, you may want to see an ear, nose and throat specialist (ENT, otolaryngologist) for your treatment options.

• #1 Perspectives in Therapy of Chronic Rhinosinusitis

  https://www.mdpi.com/2075-4418/12/10/2301

  The recent classification of chronic rhinosinusitis (CRS) focusses on investigating underlying immunopathophysiological mechanisms. The treatment selection of CRS is dependent on endotype dominance. Currently, the majority of patients receive standardized care—traditional pharmacological methods including local or systemic corticosteroids, nasal irrigations or antibiotics (for a selected group of patients). If well-conducted drug therapy fails, endoscopic sinus surgery is conducted. […] In addition, potential targets to immunotherapy in CRS are presented. Hopefully, effective diagnostic and therapeutic solutions, tailored to the individual patient, will be widely available very soon. […] The main pharmacological treatment methods used for years are saline irrigation, topical and systemic steroids and antibiotics. In certain groups of patients, leukotriene modifiers or aspirin treatment after aspirin desensitization (ATAD) can be applied. Nasal irrigations with isotonic saline or Ringer’s lactate are recommended as first line therapies in CRS, and the addition of xylitol, sodium hyaluronate, and xyloglucan may have a positive effect. Topical steroids are the first-line treatment in diffuse CRS. The effectiveness and safety of intranasal corticosteroids (INCS) in different endotypes of CRS, also pre- and post-operatively, have been confirmed in many studies. Oral corticosteroids (OCS) should be used only in the short-term (7–21 days) due to different, systemic adverse events. Short courses of OCS result in a significant reduction in symptom score and NP score and can be applied 1–2 times per year in patients with partially or uncontrolled CRS. […] In localized CRS, surgery should be performed as a first-line treatment. In diffuse CRS, surgery is indicated if the well-conducted pharmacological therapy is ineffective. The main goal of ESS is improving the severity of symptoms, achieving drainage and ventilation of the sinuses, and also decreasing inflammatory load, removing eosinophils and polyps.

• #1 Perspectives in Therapy of Chronic Rhinosinusitis

  https://www.mdpi.com/2075-4418/12/10/2301

  Monoclonal antibodies (MAb) are biologics used in oncological diseases, asthma, psoriasis, atopic dermatitis and other disorders where immune system dysfunctions are noticed. Due to the common Th-2 immune pathway, most of the biologics developed for asthma are effective in CRSwNP. Biologic treatment can be used in CRSwNP patients meeting the eligibility criteria. The randomized, placebo-controlled trials conducted so far concerned MAb directed against the specific type 2 immune response targets (IL-4, IL-5 or free IgE). In 2019, dupilumab became the first biologic approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for adult patients with inadequately controlled CRSwNP. However, so far biologics are not on the list of reimbursed medicines in all countries.

• #1 Biologic therapy effective for chronic rhinosinusitis – Otolaryngology–Head & Neck Surgery

  https://oto.wustl.edu/biologic-therapy-effective-for-chronic-rhinosinusitis/

  Chronic rhinosinusitis is one of the most prevalent chronic disorders in the US, affecting 10-15% of the population and all age groups. […] Washington University rhinologists John Schneider, MD, Cristine Klatt-Cromwell, MD, and Nyssa Farrell, MD, are seeing benefits of biologic therapy for their chronic patients when other approaches have failed. […] According to Dr. Farrell, biologics are reserved for those patients that have been unable to achieve sufficient control through surgery or topical medications like corticosteroids. […] Dupilumab is the biologic currently approved by the FDA for chronic rhinosinusitis with nasal polyps. […] They concluded that biologic therapy is indicated in patients with bilateral nasal polyps who had previously undergone sinus surgery and met three of the following criteria: evidence of Type 2 inflammation, need for systemic corticosteroids in the past two years, significant quality-of-life impairment, loss of smell, sinusitis-related asthma.

• #1 Exploring Different Treatment Approaches for Chronic Sinusitis

  https://www.sinusdoctor.com/treatment-approaches-for-chronic-sinusitis/

  Immunotherapy desensitizes the immune system to allergens, reducing allergic responses and symptoms triggered by environmental allergens. […] Probiotics may modulate immune function and reduce inflammation in the sinuses and respiratory tract, potentially benefiting chronic sinusitis management. […] In conclusion, the exploration of various treatment approaches for chronic sinusitis underscores the multifaceted nature of managing this condition. By considering a combination of medical therapies, surgical interventions, lifestyle modifications, and patient education, individuals can work towards achieving long-term symptom relief and enhancing overall sinus health.

• #1 Nasal cryotherapy for stuffy nose – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/solve-chronic-stuffy-nose-with-intense-cooling

  Do you feel like you are constantly reaching for a tissue because of a persistent dripping or stuffy nose? You don’t need to live with this annoyance anymore. A new targeted treatment is available called nasal cryotherapy. This treatment uses intense cooling to help people with chronic rhinitis. […] Nasal cryotherapy, also known as nasal cryoablation or cold therapy, is a noninvasive treatment to stop symptoms of chronic rhinitis. It uses an endoscope and cryotherapy device to freeze nerves in your nasal passages. When the cold temperature hits the nerves, the nerve signals are interrupted and no longer tell the nose to swell, drip and run. The interruption of the nerve signals provides long-lasting relief from runny or stuffy nasal symptoms. It is completed in your health care provider’s office, and you can resume most regular activities the same day. […] Talk with your primary care provider or ear, nose and throat provider if you believe nasal cryotherapy can help you.

• #1

  https://nenergyboost.com/wellness-blog/hyperbaric-oxygen-therapy-for-chronic-sinusitis/

  Chronic sinusitis is a persistent condition characterized by inflammation of the sinuses, leading to symptoms such as nasal congestion, facial pain, headache, and reduced sense of smell. […] One emerging treatment option that shows promise is hyperbaric oxygen therapy. Hyperbaric oxygen therapy is a treatment that can help effectively manage chronic sinusitis. […] Hyperbaric oxygen therapy can help treat chronic sinusitis and alleviate any symptoms that may be causing pain, discomfort, a general feeling of unwellness, and impaired quality of life. […] Hyperbaric oxygen therapy works by increasing the amount of oxygen dissolved in the blood, ensuring that oxygen reaches even the inflamed and swollen areas of the sinuses. […] Hyperbaric oxygen therapy has been shown to reduce inflammation by reducing the ability of certain chemicals in the body that lead to inflammation, and promoting the release of anti-inflammatory molecules.

• #1

  https://nenergyboost.com/wellness-blog/hyperbaric-oxygen-therapy-for-chronic-sinusitis/

  Hyperbaric oxygen therapy can enhance the body’s immune response by increasing the production and efficiency of white blood cells. […] Hyperbaric oxygen therapy aids in tissue regeneration by stimulating the production of collagen and promoting new blood vessel formation. […] Hyperbaric oxygen therapy is a non-invasive treatment option. […] HBOT can reduce the need for these medications, minimizing their potential side effects. […] Hyperbaric oxygen therapy addresses multiple aspects of chronic sinusitis, including inflammation, infection, and tissue damage. […] Hyperbaric oxygen therapy can significantly improve the quality of life for chronic sinusitis patients by reducing symptoms and the frequency of sinusitis episodes.

• #1 Chronic Sinusitis | University of Utah Health

  https://healthcare.utah.edu/ent/treatments-services/rhinology-sinus/sinusitis

  If appropriate medical management isn’t successful, the next step may be to have endoscopic sinus surgery. This surgery opens up blocked sinuses so that they can drain better and you have better access for anti-inflammatory medicine to reach your sinuses more easily. […] Endoscopic sinus surgery is minimally invasive and usually done as an outpatient procedure. Patients with other health problems, such as sleep apnea or heart disease, may need to stay at the hospital overnight. […] For the first few days after surgery, you will need to rinse your sinuses with a saline solution to keep them clean. The care team will teach you how to do this.

• #1 Exploring Different Treatment Approaches for Chronic Sinusitis

  https://www.sinusdoctor.com/treatment-approaches-for-chronic-sinusitis/

  Chronic sinusitis, a prevalent inflammatory condition affecting the nasal passages and sinuses, can significantly impair one’s quality of life, leading to persistent symptoms such as nasal congestion, facial pain or pressure, and impaired sense of smell. While the management of chronic sinusitis often requires a multifaceted approach tailored to individual patient needs, various treatment options are available to alleviate symptoms, reduce inflammation, and improve overall sinus health. […] Under the guidance of healthcare professionals and otolaryngologists like Dr. G V K Chaitanya Rao, individuals with chronic sinusitis can explore these treatment options to find the most effective and suitable approach for their specific needs. Through a combination of medical management, surgical interventions, lifestyle modifications, and patient education, the goal is to achieve long-term symptom relief, prevent disease recurrence, and enhance overall sinus health and well-being.

• #1 Chronic Sinusitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17700-chronic-sinusitis

  Chronic sinusitis treatment focuses on controlling or easing inflammation. […] Your provider may prescribe: Nasal saline irrigation. […] Nasal steroid sprays. […] Surgery to fix a deviated septum, remove nasal polyps, open up your sinuses or remove fungal balls (clumps of fungal infection that block sinuses). […] Balloon sinuplasty, a procedure that opens your sinus cavities. […] Yes, it can, depending on the cause. For example, if nasal polyps cause chronic sinusitis, removing the polyps could cure the condition. […] If that’s your situation, don’t hesitate to contact a healthcare provider. They’ll find out what caused your chronic sinusitis and recommend treatment. They’ll also recommend steps you can take to ease your symptoms while you recover.

• #1 How to Cure Sinus Infections: Treatment Options for Permanent Relief

  https://www.healthline.com/health/how-to-cure-sinus-permanently

  Several surgical approaches can enlarge the sinus cavities to make breathing and drainage easier. […] Doctors have used balloon sinuplasty as a surgical approach in the United States since 2004. […] Functional endoscopic sinus surgery or FESS is another approach your doctor may recommend to treat chronic sinusitis. […] If you choose to have sinus surgery, youll still need to use medical therapies to reduce your symptoms and prevent chronic sinusitis from coming back. […] An estimated 75 percent of people who dont respond to medical therapies find symptom relief with surgery. […] Natural remedies for sinus infections may not fully cure your symptoms, but they can work to reduce them. […] Taking steps to keep your nasal passages draining well can help you avoid sinus infections. […] Chronic sinusitis can affect your quality of life. Fortunately through medical therapies and sometimes surgery most people can find relief from their symptoms.

• #2 Chronic Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1015/p500.html

  Chronic rhinosinusitis is defined by the presence of at least two out of four cardinal symptoms (i.e., facial pain/pressure, hyposmia/anosmia, nasal drainage, and nasal obstruction) for at least 12 consecutive weeks, in addition to objective evidence. Treatment is directed at enhancing mucociliary clearance, improving sinus drainage/outflow, eradicating local infection and inflammation, and improving access for topical medications. First-line treatment is nasal saline irrigation and intranasal corticosteroid sprays. […] If medical management fails, endoscopic sinus surgery may be effective. Patients not responding to first-line medical therapy should be referred to an otolaryngologist, and selected patients with a history suggestive of other comorbidities (e.g., vasculitides, granulomatous diseases, cystic fibrosis, immunodeficiency) may also benefit from referral to an allergist or pulmonologist.

• #2 Chronic Sinusitis Treatment & Management: Approach Considerations, Control of Predisposing Factors, Symptomatic Treatment

  https://emedicine.medscape.com/article/232791-treatment

  The American Academy of Otolaryngology-Head and Neck Surgery Foundation has updated its clinical practice guidelines for the treatment of adult sinusitis. […] The recommendations to clinicians are as follows: […] Recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptomatic relief of CRS. […] Initial oral steroid therapy followed by topical steroid therapy was found to be more effective than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients with CRS with at least moderate nasal polyposis. […] In June 2019, the FDA approved dupilumab for the treatment of inadequately controlled severe chronic rhinosinusitis with nasal polyps (CRSwNP) in adults. […] In individuals with CRSwNP, the major intervention is to relieve the obstruction to sinus drainage by reducing or eliminating the polyp.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-sinusitis.aspx

  The nasal passages may be irrigated with normal saline. This is called nasal saline irrigation. […] These are usually needed in patients who have a bacterial or fungal infection of the sinuses. Antibiotics may also be needed in patients with viral infections and inflammations in case there are secondary bacterial infections. […] In case of bacterial sinusitis, 70% of patients improve within 2 weeks without antibiotics and around 85% improve with necessary antibiotics. […] If allergies are the cause of the recurrent sinusitis, anti-allergy medications like antihistamines may be prescribed. […] Patients with severe inflammation of the nasal and sinus mucosal membranes may need prescription nasal sprays with corticosteroids like Fluticasone, Betamethasone or Beclomethasone. […] Those who do not respond to medications or have long term sinusitis with anatomical problems like nasal polyps, deviated nasal septum, nasal bony spurs or large adenoids, may need surgical therapy. […] Patients are advised to avoid smoking, air pollutants, avoid allergenic triggers like pet hair, dust mites etc. to prevent onset of sinusitis.

• #2 Chronic sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667

  Treatments for chronic sinusitis include: […] Nasal corticosteroids. These nasal sprays help prevent and treat swelling. Some are available without a prescription. Examples include fluticasone (Flonase Allergy Relief, Xhance), budesonide (Rhinocort Allergy), mometasone (Nasonex 24HR Allergy) and beclomethasone (Beconase AQ, Qnasl, others). […] Saline nasal rinses. Use a specially designed squeeze bottle (NeilMed Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear sinuses. Saline nasal sprays also are available. […] Corticosteroids shots or pills. These medicines ease severe sinusitis, especially for those who have nasal polyps. The shots and pills can cause serious side effects when used long term. So they’re used only to treat severe symptoms. […] Allergy medicines. Using allergy medicines might lessen allergy symptoms of sinusitis caused by allergies.

• #2 Chronic Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1015/p500.html

  The goals of treatment in patients with chronic rhinosinusitis are to manage symptoms and improve or maintain quality of life. Treatment is directed at enhancing mucociliary clearance, improving sinus drainage/outflow, eradicating local infection and inflammation, and improving access for topical medications. Treatment consists of medical management, and endoscopic sinus surgery if appropriate medical management is unsuccessful. […] Multiple studies have demonstrated that at least daily saline irrigations reduce symptoms and improve quality of life in patients with chronic rhinosinusitis. Low-pressure, high-volume (240 mL) saline irrigation may significantly reduce sinonasal symptoms in 50% of patients and is superior to nasal saline spray in reducing sinonasal symptoms. […] Many RCTs have demonstrated that intranasal corticosteroid sprays improve sinonasal symptoms and endoscopic findings in chronic rhinosinusitis. […] Endoscopic sinus surgery is an effective treatment of chronic rhinosinusitis when appropriate medical therapy is ineffective. The goals of endoscopic sinus surgery in the treatment of chronic rhinosinusitis are to provide ventilation and drainage of the paranasal sinuses and to enlarge the paranasal sinuses to create greater access for topical medications.

• #2 Patient education: Chronic rhinosinusitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics/print

  Potential treatments for chronic rhinosinusitis include: Lifestyle modifications — People with chronic rhinosinusitis who smoke cigarettes should stop. […] Daily nasal saline washing — Most people with chronic rhinosinusitis find that washing/irrigating their nasal passages daily with saline (salt water) helps reduce symptoms. […] Antiinflammatory steroids — Because all forms of chronic rhinosinusitis involve some degree of inflammation (ie, irritation and swelling), most people with the condition need medications to reduce inflammation. […] Sprays and rinses — Your health care provider will probably ask you to try a steroid nasal spray initially, as sprays are easy to use. […] Steroid pills — In some cases, your health care provider will recommend taking steroid pills by mouth (orally). The most commonly used oral steroid is prednisone.

• #2 Chronic Sinusitis (in Adults) – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-sinusitis-in-adults-a-to-z

  If you think you have sinusitis, you can try some things at home first to help reduce swelling and open blocked sinuses. Inhaling steam and using nasal saline spray washes often helps. Decongestants, by mouth or nasal spray, are available without a prescription and can help to relieve the pressure. To control the pain, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others). […] Because chronic sinusitis often is caused by inflammation related to allergies, identifying, treating and preventing your allergies helps to relieve the sinusitis. Allergy medications include antihistamines, decongestants, leukotriene inhibitors and anti-inflammatory medications. […] Corticosteroid nasal sprays also can relieve nasal swelling and sinus inflammation. If these sprays don’t help, you may need a trial of oral steroids, such as prednisone. If there is evidence of active bacterial infection, you may need to take a course of antibiotics.

• #2 Chronic Sinusitis Medication: Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Tetracyclines, Anti-Infectives, Decongestants, Corticosteroids, Nasal sprays, Mast cell stabilizers, Expectorants, Leukotriene Receptor Antagonist, Interleukin Inhibi

  https://emedicine.medscape.com/article/232791-medication

  Antimicrobials effective against S aureus may also be needed. Whenever methicillin-resistant S aureus (MRSA) is present, vancomycin or linezolid should be administered. […] Antibiotics can also be administered topically with or without a nebulizer. This mode of administration is used in patients who have had prior sinus surgery. […] These agents are particularly effective for chronic sinusitis associated with allergic rhinitis, nasal polyps, and rhinitis medicamentosa. Corticosteroids can be administered in the form of nasal sprays or solutions. Topical steroids along with systemic antibiotics are now the key components of the medical armamentarium in the management of chronic sinusitis. […] Inhibition of interleukins 4 and 13 with dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) has shown to decrease polyp burden and improve symptoms. […] Dupilumab, (Dupixent), is a monoclonal antibody blocking interleukin 4 and interleukin 13, used for allergic diseases such as eczema, asthma and nasal polyps which result in chronic sinusitis.

• #2 Perspectives in Therapy of Chronic Rhinosinusitis

  https://www.mdpi.com/2075-4418/12/10/2301

  Dupilumab is a fully HuMAb that inhibits type 2 inflammation through blocking the shared receptor component for IL-4 and IL-13—IL-4 receptor α chain (IL-4Rα), resulting in blocking those two cytokine signalling pathways through the STAT6 pathway. Currently, dupilumab is indicated as being added to the daily standard of care in adult patients with uncontrolled CRSwNP and is also used in other conditions characterized by local and systemic eosinophilia such as atopic dermatitis and asthma. Dupilumab added to INCS therapy reduced severity of symptoms, endoscopic polyp size, sinus opacification, markers of Th2 inflammation and, in patients with coexisting asthma, improved pulmonary function (forced expiratory volume in one second) and control of asthma symptoms. […] Various biologics have been confirmed to be effective as add-on treatments to INCS and those drugs are particularly important in the therapy of patients with recurrent polyps, resistant to conventional methods of treatment. Hopefully, effective therapeutic solutions for every endotype will be widely available very soon.

• #2 Relieve Your Chronic Sinusitis with Immunotherapy Treatment

  https://drmatorin.com/relieve-your-chronic-sinusitis-with-immunotherapy-treatment/

  With customized immunotherapy shots, you won’t have to guess whether or not your allergy shot will work. You can rest assured your customized vial has enough of what you need to get relief – every time. […] Instead, with immunotherapy treatment, visit the clinic once every 10 to 11 weeks for a new custom vial. Save time and money. It’s a win-win! […] A study from 2004 found that patients who underwent immunotherapy treatment had 72% fewer days off from work or school. […] Finally, immunotherapy treatment lets people with chronic sinusitis experience long-term relief. […] Thankfully, you don’t have to sacrifice other aspects of your health for long-term sinus relief. Immunotherapy is designed specifically as a long-term solution to reduce or even eliminate your worst allergy symptoms. […] You may want to consider seeking out allergy shots if you’re experiencing chronic sinusitis symptoms.

• #2 Sinusitis: Learn More – Treating chronic sinusitis – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279484/

  Ibuprofen, acetaminophen (paracetamol) and acetylsalicylic acid (the drug in e.g. Aspirin) can relieve the pain, but won’t make the sinusitis go away any faster. […] Dupilumab, omalizumab and mepolizumab have been approved in Germany for use in adults who have severe chronic sinusitis with nasal polyps. These biologics are used together with steroid medication. […] If the symptoms are severe and don’t improve enough or for long enough from using medication alone, some people decide to have surgery. […] The procedure most commonly used to treat chronic sinusitis is called functional endoscopic sinus surgery (FESS). […] Surgery is considered if steroid sprays and other treatments don’t relieve the symptoms enough or the inflammation spreads, increasing the risk of complications. […] FESS is also supposed to increase the effectiveness of medications or saline solutions by making it easier for them to reach the sinuses. […] This involves inserting a catheter through the nose and slowly inflating a small balloon at the opening of the sinuses.

• #2 Chronic Sinusitis Treatment – HMG Ear, Nose & Throat

  https://www.holstonmedicalgroup.com/chronic-sinusitis-treatment

  Ongoing sinus blockage is far more than a nuisance that makes breathing more difficult. Depending on the severity, it can cause serious health complications. […] A variety of treatments are available, depending on the reason your nasal passages are blocked. […] Oral corticosteroids offer short-term relief for acute sinusitis in severe episodes or if you have nasal polyps. […] Nasal sprays may work well if your problem is caused by inflammation from allergies. Sometimes, these are combined with regular saline rinses to reduce irritants. […] Allergy treatments (immunotherapy) can reduce the inflammation and provide ongoing relief. […] Balloon sinuplasty is a non-invasive procedure that opens blocked sinus passages so mucus can drain. Most patients return to normal activities within 24 to 48 hours.

• #2 Chronic Sinusitis

  https://www.laent.com/procedures/nose-sinus/chronic-sinusitis/

  Chronic sinusitis is caused when the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. This constant inflammation is often due to allergies, chronic bacterial infection or nasal polyps. […] Surgery of the nose and sinuses has experienced remarkable progress in the past 50 years, benefiting from improved imaging, better understanding of anatomy, and image-guided surgical techniques. FESS is the primary approach today for treating chronic sinusitis that doesn’t respond to other medical treatment. […] Improvement of symptoms for patients with chronic sinusitis has around a 90% success rate, and FESS has a much lower complication rate than conventional sinus surgery. […] An alternative to traditional endoscopic procedures, balloon sinuplasty, or BSP, provides a less invasive treatment with fast recovery and little patient impact. […] A study of patients receiving a balloon sinuplasty to treat chronic sinusitis reported significant symptom reduction two years post-procedure.

• #2 Surgical Treatment for Chronic Sinusitis | NYU Langone Health

  https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

  Computer guidance allows surgeons to precisely identify and remove tissue or bone while preserving surrounding structures. […] Balloon sinuplasty allows the surgeon to dilate a blocked sinus, creating open space, which allows the sinus to drain normally. […] If the sinus blockage is not responsive to balloon sinuplasty, or if symptoms of chronic sinusitis are severe, doctors may choose to perform this procedure in combination with endoscopic or image-guided sinus surgery. […] After surgery, NYU Langone doctors schedule several follow-up appointments in order to monitor your recovery. Our doctors also provide continued support to ensure that symptoms of chronic sinusitis are effectively managed.

• #2 Sinus Infection (Sinusitis or Rhinosinusitis) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/sinus-infection-sinusitis-or-rhinosinusitis

  When a CT scan shows that a patient has a blockage, deviated septum or small bumps in the nasal lining (nasal polyps) that are causing chronic sinusitis, sinus surgery may be recommended to alleviate the source of the inflammation. […] Our multidisciplinary team, including pulmonary, allergy and immunology experts, allows us to effectively identify causes of sinusitis and develop personalized plans for treatment. Yale Medicine provides cutting-edge medical and surgical therapies, including clinical trials, to optimize treatment of sinusitis.

• #2 Exploring Different Treatment Approaches for Chronic Sinusitis

  https://www.sinusdoctor.com/treatment-approaches-for-chronic-sinusitis/

  Immunotherapy desensitizes the immune system to allergens, reducing allergic responses and symptoms triggered by environmental allergens. […] Probiotics may modulate immune function and reduce inflammation in the sinuses and respiratory tract, potentially benefiting chronic sinusitis management. […] In conclusion, the exploration of various treatment approaches for chronic sinusitis underscores the multifaceted nature of managing this condition. By considering a combination of medical therapies, surgical interventions, lifestyle modifications, and patient education, individuals can work towards achieving long-term symptom relief and enhancing overall sinus health.

• #2 Adult Sinusitis – Clinical Practice Guideline | AAFP

  https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/adult-sinusitis.html

  Chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis should be distinguished from isolated episode of ABRS. […] The diagnosis of CRS should be confirmed with documentation of sinonasal inflammation using anterior rhinoscopy, nasal endoscopy, or computed tomography. […] Saline nasal irrigation, intranasal corticosteroids, or both should be prescribed for symptom relief in patients with CRS.

• #2 Patient education: Chronic rhinosinusitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics/print

  Antibiotics — Although chronic rhinosinusitis is often caused by inflammation rather than infection, sinus infections can develop and aggravate symptoms. As a result, some people need to take antibiotics. […] Surgery — Although health care providers usually attempt to get the symptoms of chronic rhinosinusitis under control with medication first, some people need surgery to reopen the sinus drainage pathways and remove trapped mucus or polyps.

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