Recalcitrant chronic rhinosinusitis: investigation and management.

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.