What Treatments Are Effective for Chronic Sinusitis?

Summary and Comment |
September 10, 2015

What Treatments Are Effective for Chronic Sinusitis?

  1. Thomas L. Schwenk, MD

Daily saline irrigation and intranasal corticosteroids are recommended as first-line therapy.

  1. Thomas L. Schwenk, MD

Chronic sinusitis is defined as inflammation of the paranasal sinuses that persists for >3 months. Diagnosis requires two or more of the following symptoms: facial pain, nasal obstruction, nasal discharge, and decreased sense of smell. Additional diagnostic criteria include nasal polyps, middle meatus edema or purulence, and computed tomographic evidence of sinus inflammation. In this systematic review of 12 meta-analyses (>60 randomized, controlled trials), 13 systematic reviews, and 4 randomized, controlled trials that were not included in the meta-analyses, researchers identified the most effective medical therapies for managing chronic sinusitis in adults.

Evidence supports daily use of saline irrigation plus topical intranasal corticosteroids as first-line therapy. A short course of systemic corticosteroids (1–3 weeks) or doxycycline (3 weeks) or leukotriene-antagonist therapy is recommended for patients with nasal polyps; anti-IgE therapy (i.e., omalizumab [Xolair]) might be considered for those with asthma, nasal polyposis, and chronic sinusitis. For patients without polyps, long-term (>3 months) macrolide therapy or short-term (<3 weeks) nonmacrolide antibiotics might be effective. Evidence does not support routine use of antihistamines, allergy immunotherapy, topical antifungals, or topical antibiotics.

Comment

Chronic sinusitis is a frustrating condition for both patients and clinicians, resulting in many approaches to medical therapy. These results give some focus to the relatively few treatment strategies for which reasonable evidence exists.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

Citation(s):

Reader Comments (2)

Alex Buder , M.D. Physician, Internal Medicine, Union Health Service , Chicago, Illinois.

Any role for Endoscopic Sinus Surgey ?.

Mark Burger, PharmD Other Healthcare Professional, Pharmacology/Pharmacy, Heal First Pharmacy

"the bacterium Lactobacillus sakei may be singularly capable of warding off the painful sinusitis suffered each year by thirty million Americans; the incidence of sinusitis is far lower among people who retain that particular microbe, WHICH IS DESTROYED BY ANTIBIOTICS"

Intransal steroids thin mucous membranes and systemically disturb HPA-Axis regulation (despite what Pharms tells you).

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