Treatment: Treatment for Chronic Rhinosinusitis

What are the treatment options for chronic rhinosinusitis?

There’s no cure for chronic rhinosinusitis but there are a number of medical and surgical treatment options that can help control the condition and improve symptoms. These include:

• Saline Irrigation (Saltwater rinses)
• Intranasal corticosteroids (Nasal steroid sprays or drops)
• Antibiotics
• Corticosteroids
• Biologics
• Surgery

Saline Irrigation

Regular saline nasal irrigation is a helpful and effective initial treatment for most patients with chronic rhinosinusitis. It reduces symptoms by improving the flow of mucus, and may also help by washing away irritants and allergens in the nose.

Steroids are often added to saline irrigation solutions so that they can be rinsed into the sinus cavities for better distribution, especially after surgery.

Intranasal corticosteroids

Nasal steroid medication is the main treatment used for most patients with chronic rhinosinusitis with or without polys.

Intranasal corticosteroids act to soothe the nasal lining, reversing some of the effects of inflammation. This helps to reduce symptoms and may make breathing through the nose easier, improve the sense of smell and reduce nasal discharge.

Corticosteroids may also be effective in reducing the size of nasal polyps if present, resulting in further improvement of symptoms.

A regular maintenance intranasal corticosteroid will also often be used after surgery to help prevent nasal polyps from coming back.

Modern formulations are safe to use long-term as they are made in a way to ensure that they have very little absorption in the blood stream.

Antibiotics

Long-term antibiotic medications may be used to treat chronic rhinosinusitis. It’s believed that rather than simply killing the bacteria directly, antibiotic treatment may work by altering the immune system’s response to the bacteria.

Short term antibiotics may be used if there is an acute flare up of bacterial infection; this can happen after a cold or dental problems.

Corticosteroids

A consultant may prescribe oral corticosteroids to reduce inflammation in particularly severe cases of chronic rhinosinusitis, especially in the presence of nasal polyps, or if other therapies have been ineffective.

They can help can reduce the size of your nasal polyps (if present) and improve nasal breathing and sense of smell within days. Unfortunately, this change is not permanent and some patients will experience a relapse of some symptoms after steroid treatment has ended.

Steroids may occasionally be prescribed in the lead-up to sinus surgery to help reduce inflammation for a more straightforward procedure, although this is not needed in most cases.

Biologics

Biologic agents are a new option that can be added to patients’ treatment plans. They are usually considered for severe patients whose chronic rhinosinusitis with nasal polyps has not responded to surgery and appropriate medical therapies.

Polyps, if they are present, may stop growing or often significantly reduce in size. In turn, patients feel like they can breathe more easily through the nose, have less problematic nasal discharge, and their sense of smell may return.

Some patients with sinus disease may also be considered for biologic treatment because they have asthma which is difficult to control, with the aim of significantly improving their nasal symptoms. Functional Endoscopic Sinus Surgery (FESS)

Unfortunately the costs of biologics are not currently reimbursed within the NHS and these will not be suitable to all patients as a result.

Surgery

For some patients, the medical treatments listed above won’t be enough to control symptoms alone. If a patient is already taking the maximum amount of medical treatment, but their symptoms are still affecting their quality of life, endoscopic sinus surgery (ESS) can be considered in order to give them better control of their condition.

Endoscopic Sinus Surgery (ESS) is a term used to describe the most common technique for operating on sinus disease.