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Recalcitrant chronic rhinosinusitis: investigation and management

Woodbury, Kristin; Ferguson, Berrylin J

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2011 - Volume 19 - Issue 1 - p 1–5
doi: 10.1097/MOO.0b013e3283420e92
Nose and paranasal sinuses: Edited by Anshul Sama

Purpose of review We discuss the care of patients failing the typical medical and surgical management for chronic rhinosinusitis who need further evaluation to rule out various mimics of sinus disease and other disorders that may require specific treatment plans. We also look at the many treatment options for the recalcitrant sinusitis patient recently published.

Recent findings Work-up of diseases such as gastroesophageal reflux, dental infection and immunodeficiency in the chronic rhinosinusitis patient are discussed. There have been multiple treatment options evaluated in the literature in the past year, including long-term macrolide therapy and various antibiotic, antifungal, and surfactant irrigations. Recommendations regarding these therapies are discussed.

Summary Patients with recalcitrant chronic rhinosinusitis offer a significant challenge to the otolaryngologist. This review provides a structured look at both diagnosing and treating the disease processes in these patients, with recently published literature presented.

Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Correspondence to Kristin Woodbury, Fellow of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Mercy Building D, Suite 2100, 1400 Locust Street, Pittsburgh, PA 15219, USA Tel: +1 412 232 3687; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.