[Conservative therapy of the chronic rhinosinusitis]

Chronic inflammation of nasal mucosa and sinuses are of increasing prevalence. Patients suffering from chronic rhinosinusitis (CRS) are characterised by nasal obstruction and secre- tion, impaired sense of smell, head and facial pain, causing impact on quality of life as well as tremendous socioeconomic effects. Therefore, effective and specific diagnostics as well as therapies are essential, which have to be selected from state of the art, evidence based guidelines. According to EP3OS guidelines from 2007 the CRS is defined as chronic inflammation of the nose and nasal sinuses, with or without nasal polyps (CRSwNP/CRSsNP). Upon shown diagnostic criteria of CRS first choice of therapy should be topical glucocorticoids causing anti-inflammatory and curative effects. Improvement of nasal symptoms can be achieved by hypertonic salt solutions. Median to severe symptoms of CRSsNP might be improved by longterm-treatment with oral macrolides. Patients suffering additionally from allergies will benefit from antihistamines, whereas those suffering from analgesic-intolerance (AI) will show improvement upon adaptive desensitisation. Leukotriene receptor antagonists, anti-IgE-antibodies (Omalizumab) or anti-interleukin-5- antibodies (Mepolizumab) are new therapeutic options for the treatment of CRS. This paper reviews recent pharmacologic and non-pharmacologic therapeutic options for conservative treatment of CRS. In addition, evidence based therapeutic options of CRS treatment are evaluated.