Management of Chronic Sinusitis

First-Line Therapy

Intranasal corticosteroids are the cornerstone of treatment for chronic sinusitis due to their anti-inflammatory effects and documented efficacy in relieving nasal congestion, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
Saline irrigation prevents crusting of secretions and facilitates mechanical removal of mucus, with hypertonic saline potentially improving mucociliary clearance more effectively than normal saline 2

For chronic infectious sinusitis, longer duration of therapy may be required, with attention to anaerobic pathogens, according to the Infectious Diseases Society of America 3, 4
Antibiotics play a controversial role in non-infectious chronic sinusitis and should not be the primary treatment, as stated by the American Academy of Otolaryngology 3, 4

Decongestants may provide symptomatic relief by widening ostia and reducing turbinate swelling, but should be used cautiously due to potential systemic effects, as advised by the American College of Allergy, Asthma, and Immunology 5
Antihistamines, particularly for patients with an allergic rhinitis component, and mucolytics and expectorants may provide symptomatic benefit in selected cases, according to the American Academy of Allergy, Asthma, and Immunology 1, 3

Underlying conditions such as allergic rhinitis, gastroesophageal reflux disease (GERD), and immunodeficiency should be evaluated and treated, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 3
Specialist referral is indicated when sinusitis is refractory to usual treatment, recurrent, or significantly affects quality of life, as suggested by the American Academy of Otolaryngology 3, 4

Overuse of antibiotics should be avoided unless there is clear evidence of bacterial infection, as cautioned by the Infectious Diseases Society of America and the American College of Chest Physicians 3, 6