eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Sinusitis, Chronic, Medical Treatment: Follow-up

Author: Seth M Brown, MD, MBA, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Director, The Connecticut Sinus Institute
Coauthor(s): Marvin P Fried, MD, FACS, Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine; Babak Sadoughi, MD, Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine; Osama A Abdel Razek, MB, BCh, MSc, Research Fellow, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard University Medical School; Dennis Poe, MD, Clinical Assistant Professor, Departments of Otology and Laryngology, Harvard University Medical Center, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Further Inpatient Care

  • Generally, chronic rhinosinusitis (CRS) can be treated on an outpatient basis. If intracranial or orbital complications are suggested, the patient should be admitted and properly investigated.

Further Outpatient Care

  • Nasal douching may improve symptoms, particularly following surgical treatment.
  • Steam inhalation may have a role to liquefy and soften crusts while moisturizing dry inflamed mucosa.
  • Nasal cavity irrigation using buffered normal saline may have a role in decreasing mucosal edema. Irrigation should be performed at least twice daily.
  • Patients with presumed allergic rhinitis in conjunction with chronic sinusitis may benefit from an evaluation by an otolaryngologist trained in otolaryngic allergy or an allergist/immunologist. In most instances, prick/puncture tests are performed to clarify the role of allergies.

Transfer

  • Ophthalmology or neurosurgery consultation should be sought in those cases in which sinusitis has spread beyond the paranasal sinuses.
  • Neurology consultation should be considered in cases of sinus symptoms without positive findings on CT to evaluate for migraine or other neurological causes for the patient's symptom.

Complications

  • The most common complication of chronic sinusitis is superimposed acute sinusitis.
  • In children, the presence of pus in the nasopharynx may cause adenoiditis, and a high percentage of such patients develop secondary serous or purulent otitis media.
  • Dacryocystitis and laryngitis may also occur as complications of chronic sinusitis in children.
  • Orbital complications include preseptal cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, and cavernous sinus thrombosis.
  • Intracranial complications include meningitis, epidural abscess, subdural abscess, and brain abscess.
  • Other complications include osteomyelitis or mucocele formation.

Patient Education

  • Patients should be educated on the importance of smoking cessation because tobacco use has negative effects on sinus function as well as other negative health effects.
  • For excellent patient education resources, see the eMedicine's patient article Sinus Infection.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify and treat sinusitis in cases that progress to more serious infections beyond the paranasal sinuses
  • Failure to consider malignancy, particularly in cases that are unilateral in nature or that demonstrate a nasal mass on examination or imaging

Special Concerns

  • Rhinitis of pregnancy is an entity that should be entertained in women who present with sinus symptoms for the first time during pregnancy.
  • Pediatric patients with chronic rhinosinusitis (CRS) and particularly with nasal polyps should be assessed for immunodeficiency, especially cystic fibrosis.
 


More on Sinusitis, Chronic, Medical Treatment

Overview: Sinusitis, Chronic, Medical Treatment
Differential Diagnoses & Workup: Sinusitis, Chronic, Medical Treatment
Treatment & Medication: Sinusitis, Chronic, Medical Treatment
Follow-up: Sinusitis, Chronic, Medical Treatment
Multimedia: Sinusitis, Chronic, Medical Treatment
References
Further Reading
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References

  1. Rosenfeld RM. Clinical practice guideline on adult sinusitis. Otolaryngol Head Neck Surg. Sep 2007;137(3):365-77. [Medline].

  2. Wise SK, Ahn CN, Lathers DM, Mulligan RM, Schlosser RJ. Antigen-specific IgE in sinus mucosa of allergic fungal rhinosinusitis patients. Am J Rhinol. Sep-Oct 2008;22(5):451-6. [Medline].

  3. Benninger MS, Payne SC, Ferguson BJ, et al. Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. Jan 2006;134(1):3-9. [Medline].

  4. Ponikau JU, Sherris DA, Weaver A, et al. Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, double-blind pilot trial. J Allergy Clin Immunol. Jan 2005;115(1):125-31. [Medline].

  5. Bhattacharyya N. Radiographic stage fails to predict symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. Jan 2006;116(1):18-22. [Medline].

  6. Arjmand EM, Lusk RP. Management of recurrent and chronic sinusitis in children. Am J Otolaryngol. Nov-Dec 1995;16(6):367-82. [Medline].

  7. Druce HM. Adjuncts to medical management of sinusitis. Otolaryngol Head Neck Surg. Nov 1990;103(5(Pt 2)):880-3. [Medline].

  8. Druce HM. Diagnosis and medical management of recurrent and chronic sinusitis in adults. In Gershwin, M. Eric and Incaudo, Gary : Diseases of the Sinuses A Comprehensive Textbook of Diagnosis and Treatment. Humana press,Totowa, NJ, USA. 1996;215-31.

  9. Eloy P, Bertrand B, Rombaux P. Medical and surgical management of chronic sinusitis. Acta Otorhinolaryngol Belg. 1997;51(4):271-84. [Medline].

  10. Friedman WH, Katsantonis GP, Bumpous JM. Staging of chronic hyperplastic rhinosinusitis: treatment strategies. Otolaryngol Head Neck Surg. Feb 1995;112(2):210-4. [Medline].

  11. Gold SM, Tami TA. Role of middle meatus aspiration culture in the diagnosis of chronic sinusitis. Laryngoscope. Dec 1997;107(12 Pt 1):1586-9. [Medline].

  12. Gwaltney JM Jr, Jones JG, Kennedy DW. Medical management of sinusitis: educational goals and management guidelines. The International Conference on sinus Disease. Ann Otol Rhinol Laryngol Suppl. Oct 1995;167:22-30. [Medline].

  13. Lund VJ. Maximal medical therapy for chronic rhinosinusitis. Otolaryngol Clin North Am. Dec 2005;38(6):1301-10, x. [Medline].

  14. Marshall KG, Elhamy A. Chronic sinusitis. In: Disorders of the Nose and Paranasal Sinuses: Diagnosis and Management. PSG Publishing: Littleton, Mass; 1987.

  15. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. Dec 2004;114(6 Suppl):155-212. [Medline].

  16. Nagi MM, Desrosiers MY. Algorithms for management of chronic rhinosinusitis. Otolaryngol Clin North Am. Dec 2005;38(6):1137-41, vii. [Medline].

  17. Pang YT, Willatt DJ. Do antral washouts have a place in the current management of chronic sinusitis?. J Laryngol Otol. Oct 1996;110(10):926-8. [Medline].

  18. Parsons DS. Chronic sinusitis: a medical or surgical disease?. Otolaryngol Clin North Am. Feb 1996;29(1):1-9. [Medline].

  19. Stafford CT. The clinician's view of sinusitis. Otolaryngol Head Neck Surg. Nov 1990;103(5 (Pt 2)):870-4; discussion 874-5. [Medline].

  20. Weir NA. Infective rhinitis and sinusitis. In: Scott-Brown WG, Kerr AG, eds. Scott-Brown's Otolaryngology. Vol 3. 6th ed. Boston, Mass: Butterworth-Heinemann Medical; 1997:8, 23-5.

  21. Witsell DL, Stewart MG, Monsell EM, et al. The Cooperative Outcomes Group for ENT: a multicenter prospective cohort study on the effectiveness of medical and surgical treatment for patients with chronic rhinosinusitis. Otolaryngol Head Neck Surg. Feb 2005;132(2):171-9. [Medline].

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Further Reading

Clinical guidelines

Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC 3rd, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJ, Nathan R, Shiffman RN, Smith TL, Witsell DL. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007 Sep;137(3 Suppl):S1-31. 1

University of Michigan Health System. Acute rhinosinusitis in adults. Ann Arbor (MI): University of Michigan Health System; 2007 Mar. 8 p.

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Keywords

sinusitis, chronic sinusitis, chronic rhinosinusitis, recurrent sinusitis, chronic rhinitis, recurrent rhinitis, runny nose, sinus congestion, chronic congestion, chronic sinus congestion, recurrent sinus congestion, chronic cold, recurrent cold

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Contributor Information and Disclosures

Author

Seth M Brown, MD, MBA, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Director, The Connecticut Sinus Institute
Seth M Brown, MD, MBA is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Rhinologic Society, and North American Skull Base Society
Disclosure: Nothing to disclose.

Coauthor(s)

Marvin P Fried, MD, FACS, Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
Marvin P Fried, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, American Society of Plastic and Reconstructive Surgery, Massachusetts Medical Society, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Entrigue Consulting fee Board membership

Babak Sadoughi, MD, Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
Babak Sadoughi, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Association for Research in Otolaryngology, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Osama A Abdel Razek, MB, BCh, MSc, Research Fellow, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard University Medical School
Disclosure: Nothing to disclose.

Dennis Poe, MD, Clinical Assistant Professor, Departments of Otology and Laryngology, Harvard University Medical Center, Boston University School of Medicine
Dennis Poe, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Otological Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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