Treatment of rhinosinusitis
The aim of rhinosinusitis treatment is to reduce sinonasal inflammation, eliminate the underlying cause, decrease the number of flare-ups, and maintain the nasal cavities unobstructed.
The initial treatment depends on the severity of the disease. If it is mild, management starts with symptomatic treatment (decongestants, saline solution, painkillers). Topical corticosteroids are administered in moderate cases, which are accompanied by antibiotics and oral corticosteroids in severe cases.
Nasal irrigation with physiological saline and hypertonic saline solution. To alleviate symptoms by flushing any retained mucus; used for both acute and chronic rhinosinusitis.
Including the following treatments, amongst others:
Nasal corticosteroids. These are nasal aerosol sprays with anti-inflammatory effect. They have a very low absorption in blood, so their effect only acts on the nose. Some examples are fluticasone, triamcinolone, budesonide, mometasone and beclomethasone dipropionate.
Oral corticosteroids. These medications are used to reduce the inflammation in severe rhinosinusitis, especially in patients who also have polyps. Oral corticosteroids can produce strong side effects when used for prolonged periods, so they are only used to treat severe symptoms.
Acetylsalicylic acid desensitisation treatment in the event of reactions that produce rhinosinusitis. Under medical supervision, patients are administered gradually increasing doses of acetylsalicylic acid to increase their tolerance.
Antibiotics. Rhinosinusitis must occasionally be treated with antibiotics, above all in cases of acute bacterial rhinosinusitis.
Nasal decongestants. These can be used for short periods in the treatment of acute rhinosinusitis in order to decrease nasal congestion and improve sinus ventilation and drainage. There is no evidence that they are effective against chronic rhinosinusitis.
Immunotherapy. If allergies aggravate the rhinosinusitis, injectable or sublingual allergy vaccinations (immunotherapy) help reduce the body’s reaction to specific allergens.
Sinonasal surgery is indicated for patients who have chronic rhinosinusitis and are unable to achieve good control of the symptoms. Surgery is currently performed under general anaesthesia and almost always endoscopically, in other words, using an endoscope with a camera and light at the end, so the surgeon can work inside the nose without making any external incisions.
Prior to surgery, patients must undergo a CT scan to detect if they have an unusual anatomy (anatomical variation). Surgery is individualised to each patient and adjusted to the extent of the disease. The sinuses obstructed by mucus and/or polyps are opened and any nasal polyps, if present, are resected. After the operation, the patient’s nose is packed with gauze for 48 hours to minimise the risk of bleeding.
The biological medicines currently being investigated for rhinosinusitis treatment are monoclonal antibodies that mostly act by interfering at different points of the inflammatory response. These medicines are able to control the most severe cases, thus replacing current medicines and the need for repeated surgeries. However, they are not yet available on the market because they are still subject to research.
Nasal irrigation. Nasal dryness and irritation. Other rare side effects are nausea secondary to irrigation, burning, cough, dizziness and tearing.
Nasal corticosteroids. The effects are similar to those produced by nasal irrigation, primarily dryness and irritation.
Oral corticosteroids. Oral corticosteroids long-term use can have effects on the patient’s metabolism such as weight gain, osteoporosis, retarded growth, skin atrophy, diabetes, high blood pressure, cataracts, etc., and therefore the minimum effective dose must be administered for the least amount of time possible.
Antibiotics. Among the most common side effects of antibiotics are dizziness, diarrhoea and, in women, vaginal fungal infections. Some reactions are more serious and, depending on the antibiotic, can affect liver and kidney function. Antibiotics can also cause allergic reactions. In most cases these are mild and involve the appearance of a pruritic (itchy) rash or slight wheezing. Another significant consequence of antibiotic therapy is the development of resistance. Antibiotic resistance is a major public health problem and there is a growing consensus that the use of antibiotics is the main factor that establishes the selective pressure responsible for this resistance.
Nasal decongestants. The most common adverse effect associated with the topical administration of nasal decongestants is the reappearance of nasal congestion (rebound) in patients who have used these agents over extended periods or used them abusively. This effect comes about after using the medication for between 5 and 7 days.
Surgical complications. Aspects that give rise to complications are the large degree of anatomical variability in this region, and the proximity to the brain and eyes.