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

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Abstract:

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.

Keywords: Antibiotics; chronic rhinosinusitis; intranasal corticosteroids; medical therapy; nasal polyps; saline lavages; surgical therapy

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2013.34.3636

Publication date: March 1, 2013

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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