ABSTRACT
This chapter covers the medical treatment, in particular the use of corticosteroids and antibiotics, in managing the various types of rhinosinusitis. The classification of rhinosinusitis includes: acute rhinosinusitis (ARS), and then chronic rhinosinusitis with (CRSwNP) or without (CRSsNP) nasal polyps. A Cochrane review suggests systemic steroids may be a useful adjunctive therapy to oral antibiotics in the short-term relief of symptoms of ARS. A number of randomized controlled trials (RCTs) have tested nasal irrigation with isotonic or hypertonic saline in the treatment of ARS and CRS comparing modalities of application. There was limited evidence of benefit with nasal saline irrigation in adults with ARS. Irrigation with saline has also shown to significantly improve nasal mucociliary clearance, as measured by saccharine tests in healthy volunteers. Since an altered immune response to bacterial infection or fungal infection may be responsible for some of the episodes of recurrent rhinosinusitis, there is interest in medications that may alter the immune response.
