Management of chronic rhinosinusitis Adarsh K. Gupta, DO, MS, a Ashmit Gupta, MD, MPH b From the a Center for Information Mastery, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford, NJ; and b Department of Otolaryngology, Thomas Jefferson University, Voorhees, NJ. Summary Chronic rhinosinusitis (CRS) is one of the most common reasons that persons seek medical care. 1 CRS may originate from or be perpetuated by local or systemic factors predisposing to sinus ostial obstruction and infection. These factors include anatomic or inflammatory factors leading to sinus ostial narrowing, disturbances in mucociliary transport, and subsequent infection. CRS is diagnosed by various symptoms (lasting for at least 12 weeks), which include long-term nasal congestion, thick mucus production, loss of sense of smell, sinus pressure, and facial pain, as well as physical and radiographic evidence of mucosal swelling. The goal of medical management is to reduce the swelling and inflammation, especially of the ostia, and promote drainage and a more normal nasal environment. The medical treatment should include empiric broad-spectrum antibiotics with adjunctive therapy, including nasal and oral steroids, decongestants, expectorants, and saline nasal irrigation. If symptoms improve after four weeks of treatment initiation, it is recommended that the nasal steroid sprays and nasal saline irrigations should continue for at least three months. If symptoms do not improve and there is still presence of CRS signs and symptoms, the patient should be referred to an appropriate specialist for further management. © 2010 Elsevier Inc. All rights reserved. KEYWORDS: Chronic rhinosinusitis; Sinusitis Introduction Chronic rhinosinusitis (CRS) is one of the most common reasons that persons seek medical care. Experts estimate that about 31 million people in United States are affected by chronic sinusitis annually. CRS results in 18 to 22 million office visits per year, and Americans spend more than $2 billion annually on over-the-counter medications to treat CRS and other nasal and sinus disorders. 1,2 Rhinosinusitis is replacing the term sinusitis because sinusitis is often preceded by rhinitis and rarely occurs without concurrent nasal airway inflammation. 3,4 Acute rhi- nosinusitis refers to inflammation of the mucous membranes lining the paranasal sinuses of less than four weeks’ dura- tion. Subacute rhinosinusitis refers to a diseased state when the patient has symptoms of four to 12 weeks’ duration. CRS is a group of disorders characterized by inflammation of the sinonasal mucosa for at least 12 weeks’. A fourth diagnostic category, recurrent acute rhinosinusitis, is de- fined as patients who develop discrete episodes of acute infection that are separated by a period of normal function and minimal symptoms. It is important to differentiate re- current acute sinusitis from CRS. Pathophysiology CRS may originate from or be perpetuated by local or systemic factors predisposing to sinus ostial obstruction and infection. These factors include anatomic or inflammatory factors lead- Corresponding author: Adarsh K. Gupta, DO, MS, Assistant Professor, Family Medicine, Director, Center for Information Mastery, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, 42 East Laurel Rd, Suite 2100, Stratford, NJ 08084. E-mail address: guptaad@umdnj.edu. Osteopathic Family Physician (2010) 2, 4-9 1877-573X/$ -see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.osfp.2009.09.003