Management of Chronic Rhinitis with Hypersensitivity and Motor Syndrome

Diagnostic Evaluation

The American Academy of Otolaryngology-Head and Neck Surgery recommends confirming diagnosis with objective documentation of sinonasal inflammation using anterior rhinoscopy, nasal endoscopy, or computed tomography (CT) 2
Evaluation for underlying allergies through skin prick testing or blood tests for specific IgE is recommended, particularly for perennial allergens such as dust mites, cockroaches, pet dander, and fungi 3, 4
Computed tomography (CT) is considered the preferred imaging technique when radiographic imaging is needed 3, 4
Assessing for comorbid conditions that may modify management, including asthma, immunodeficiency, and ciliary dyskinesia, is crucial 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests that intranasal corticosteroids are a cornerstone therapy for symptom relief 5, 2
Saline nasal irrigation helps remove irritants, reduce congestion, and improve medication delivery 5, 2

For mild symptoms, intranasal corticosteroids and saline lavage are recommended as initial management, with monitoring of response for 3 months 5
For moderate to severe symptoms, consider higher potency intranasal corticosteroids, saline nasal lavage, and a short course of oral corticosteroids if nasal polyps are present 5

For patients not responding to initial therapy after 3 months, consider culture-directed antibiotic therapy, long-term macrolide therapy, CT evaluation, and referral for surgical evaluation 5, 7
Surgical options should be considered when medical management fails after appropriate trials, or when disease is advanced with polyps, osteitis, bony erosion, or fungal involvement 1, 7

Avoid antifungal therapy as it is not recommended for CRS management 2
Immunologic testing should be considered in patients with recurrent or persistent purulent infections, failed aggressive management, and may include quantitative immunoglobulin assays and specific antibody responses to vaccines 3, 8

Failing to confirm diagnosis with objective evidence of inflammation 2
Prescribing antibiotics without evidence of bacterial infection 2
Overlooking allergic components that could be effectively managed 3, 4
Delaying allergy evaluation until after surgical intervention 4
Implementing a rigid "one-size-fits-all" treatment regimen rather than tailoring therapy to the specific subtype and severity of disease 1