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Recalcitrant chronic rhinosinusitis: investigation and management
Kristin Woodbury1, Berrylin J Ferguson
1Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15219, USA. woodburykw@upmc.edu
Current Opinion in Otolaryngology & Head and Neck Surgery
|December 31, 2010
Summary
For chronic rhinosinusitis (CRS) patients unresponsive to standard treatments, this review covers differential diagnoses and recent therapeutic options. It highlights managing complex cases and exploring new treatments for recalcitrant CRS.
Area of Science:
- Otolaryngology
- Immunology
- Infectious Disease
Background:
- Chronic rhinosinusitis (CRS) management can fail, necessitating further investigation for alternative diagnoses.
- Recalcitrant CRS presents a diagnostic and therapeutic challenge for otolaryngologists.
Purpose of the Study:
- To review diagnostic approaches for CRS mimics and other conditions in patients refractory to typical treatments.
- To examine recently published treatment options for recalcitrant CRS.
Main Methods:
- Literature review of recent publications on chronic rhinosinusitis management.
- Discussion of diagnostic work-up for conditions mimicking CRS, such as GERD, dental infections, and immunodeficiencies.
- Evaluation of emerging therapies including long-term macrolide therapy and various irrigations.
Main Results:
- Differential diagnoses for recalcitrant CRS include gastroesophageal reflux, dental infections, and immunodeficiency.
- Recent literature highlights novel treatments like long-term macrolide therapy and specialized irrigations (antibiotic, antifungal, surfactant).
- Evidence-based recommendations for these advanced therapies are provided.
Conclusions:
- Managing recalcitrant CRS requires a systematic approach to diagnosis and treatment.
- Otolaryngologists face significant challenges with these complex CRS cases.
- This review offers a structured overview of current diagnostic and therapeutic strategies based on recent literature.
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