Adult Chronic Sinusitis and Its Complications

By G. Douglas Campbell Jr., MD, FCCP

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Medical Management of Chronic Rhinosinusitis

Steroids

Steroids, especially topical steroids, are a mainstay of rhinosinusitis treatment. They work by reducing inflammation, decreasing the sensitivity of cholinergic receptors (thereby reducing secretory response), decreasing nasal epithelial basophilia and mucosal eosinophilia, and inhibiting late-phase reaction to allergens.²⁹ When steroids are used in conjunction with antibiotics, patients exhibit symptom improvement, decreases in inflammatory cells, and regression in radiographic abnormalities.³⁰ Newer topical steroids are long-acting and appear to have minimal systemic effects, and they can be used for prolonged periods of time, especially when polyps are present. Oral steroids are beneficial, especially early in the treatment of chronic rhinosinusitis, when disease is resistant, or before surgery in patients with extensive polyps. However, side effects usually limit oral steroid use to short periods, usually < 2 weeks.

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