Resistant rhinosinusitis: what to do when usual measures fail

There are some patients with rhinosinusitis in whom the condition never clears or it recurs after a short period of time. The clinician must consider underlying conditions that must be brought under control to arrive at a satisfactory outcome. These conditions include allergy, immune deficiency, cystic fibrosis, gastroesophageal reflux, and structural abnormalities. Other disease states are important to consider because they may mimic bacterial rhinosinusitis but require other therapeutic approaches. These include chronic hyperplastic eosinophilic rhinosinusitis, fungal sinusitis, and aspirin sensitivity.