Topical Therapies for Refractory Chronic Rhinosinusitis

Area of Science:

• Otolaryngology
• Rhinology
• Medical Treatments

Background:

• Topical therapies are increasingly vital for managing refractory chronic rhinosinusitis (CRS).
• Established treatments include high-volume sinonasal saline irrigation and standard metered-dose topical nasal steroids.
• Nonstandard topical steroid applications offer potential for difficult-to-treat CRS cases.

Purpose of the Study:

• To review the current evidence on various topical therapies for chronic rhinosinusitis.
• To evaluate the efficacy and recommendations for different topical treatment modalities.
• To identify areas requiring further research in refractory CRS management.

Main Methods:

• Systematic review of existing literature on topical sinonasal treatments.
• Analysis of evidence supporting saline irrigation and standard topical steroids.
• Assessment of data for nonstandard topical steroids, antifungals, antibiotics, and stents.

Main Results:

• High-volume saline irrigation and standard topical nasal steroids have strong evidence for CRS.
• Topical antifungal and antibiotic therapies (spray/nebulized) are generally not recommended for routine CRS.
• Nasal stents show preliminary promise as an option for refractory CRS after traditional treatments fail.

Conclusions:

• Topical therapies are essential for refractory chronic rhinosinusitis (CRS).
• Saline irrigation and standard topical steroids are evidence-based mainstays.
• Further research on long-term outcomes of novel treatments like stents for refractory CRS is necessary.