14
Treatment
Duration
≥12 weeks
Two or more of following symptoms:
• Nasal Obstruction/Congestion
• Nasal Discharge (Anterior/Posterior)
• Facial Pain/Pressure
• Loss of Smell
RECOMMENDED OPTION
AERD - Aspirin Exacerbated Respiratory Disease, AMT - Appropriate Medical
Therapy, ASA - Aspirin, CRS - Chronic Rhinosinusitis, CS - Corticosteroid,
CT - Computed Tomography, IGS - Image Guided Surgery
Diagnosis
Medical
Management
AMT
Surgery
Peri-Surgical
AND
IF
CONFIRMED
IF
TREATMENT
FAILURE
RECONSIDER
AMT
IF
AMT
FAILURE
CONSIDER
SURGERY
AFTER
SURGERY
CONSIDER
CONTINUED
MEDICAL
MANAGEMENT
IN
SEVERE
CRSWNP
WITH
MEDICAL/SURGICAL
FAILURE
CONSIDER
BIOLOGIC
PERI-OP CONSIDER
ALL CRS
Saline Irrigation
• >8 weeks
• High volume CS
Irrigations
CRSwNP
INCS
CS Atomization
CS Nebulization
Oral CS
• Short term
AERD
ASA Desensitization
Duration
3–4 week trial
CRSsNP
Oral Antibiotic
CRSsNP
Oral steroids
CRSwNP
Oral Antibiotic
Hypotensive Anesthesia
• MAP 60–70 mmHg
SNOT-22 Based Selection
• SNOT-22 ≥20
Less Extensive Surgery
• In minimal disease
Use of IGS
Saline Irrigations
Sinus Cavity Debridement
Topical CS
Oral Antibiotic
Systemic CS
Post-Operative Packing
CS Eluting Stent
ALL CRS
Hypertonic Saline
Macrolide Antibiotics
Xylitol Irrigation
CRSwNP
ICS Eluting Implants
CS Exhalation Delivery
Anti-Leukotrienes
Furosemide
Biologics
CRSsNP
INCS
Figure 3. Management of Rhinosinusitis
