Interfacing medical and surgical management for chronic rhinosinusitis with and without nasal polyps

The development of FESS provided the otolaryngologist with an approach for restoring sinus ostial patency while simultaneously maximizing the restoration of normal mucociliary function. While minor modifications to the basic procedure continue to be discussed, FESS is widely accepted as the standard of care for surgical management of CRS. Image-guided surgery offers further promise of allowing more precise surgery with fewer intraoperative complications. Most patients with CRS who fail medical therapy will benefit from FESS with improved outcomes and possibly improvement in comorbidities, especially asthma. Postoperative medical management and attention to contributive factors for disease, such as the presence of allergies and aspirin intolerance, are key factors toward assuring successful surgical outcomes. The surgical approach and outcomes vary somewhat based on whether the patient has CRS without NP, CRS with NP, or classic AFRS. Furthermore, the goals of surgery depend on whether other underlying conditions, such as cystic fibrosis, are present. The last section in this chapter provides guidance as to the combined medical and surgical management of various forms of CRS based on existing evidence from the literature.