Reviews and feature articleChronic rhinosinusitis: Epidemiology and medical management
Section snippets
Anatomic abnormalities
Certain anatomic variants, such as septal deviation, Haller cells, paradoxical curvature of the middle turbinate, and agger nasi cells, have been suggested to predispose to obstruction of the ostiomeatal unit, development of CRS, or both. However, there is currently little evidence that these play a role in most cases of chronic sinusitis.9, 10, 11, 12 Furthermore, a recent study in a pediatric population found no correlation between anatomic abnormalities and the extent of CRS on sinus CT
Nasal saline
Nasal saline irrigation and nasal spray are helpful in all types of CRS. A systematic review of 8 studies using various forms of irrigation and saline sprays (performed 1-4 times daily) found that nasal saline is an effective adjunctive treatment for CRS, although less effective as monotherapy than topical glucocorticoids.63 Nasal saline irrigation is recommended in each of the recent rhinosinusitis consensus documents. Irrigation reduces postnasal drainage, removes secretions, rinses away
Overview
Several recent consensus documents have been published addressing CRS.65, 70, 106, 107, 108 Each acknowledges the lack of controlled treatment trials for CRS. As a result, treatment recommendations are based heavily on expert opinion rather than high-grade clinical evidence. Presently, there are no US Food and Drug Administration–approved treatments for CRS, and intranasal mometasone furoate is the only US Food and Drug Administration–approved therapy for treatment of NP.
The most comprehensive
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Series editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD