Medical Management of Chronic Rhinosinusitis in Children and Adults

Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the nasal passageways and sinuses lasting over 12 weeks. CRS is treated with multiple medical therapies in children and adults. Topical nasal corticosteroids are recommended for CRS with and without nasal polyps by multiple rhinosinusitis guidelines and evidence-based meta-analyses. The safety profile of nasal corticosteroids is excellent. The majority of studies show no adrenal suppression. Further, no growth suppression is seen in children using low dosages and side effects are generally mild. Nasal saline irrigation has also led to an improvement in symptom scores and quality of life measures using isotonic and hypertonic saline solutions. A Cochrane review states that medical management of CRS is as effective as surgical therapy based on available data. This highlights the important role of specialists in allergy/immunology and otolaryngology that have expertise in the treatment of CRS. Additional high-level evidence is urgently needed to best define optimal treatment strategies and which subgroups of CRS may respond best to the various medical treatments.