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Medical Therapy in the Preoperative and Postoperative Period

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Book cover Practical Medical and Surgical Management of Chronic Rhinosinusitis

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Abstract

Optimal medical management of chronic rhinosinusitis (CRS) is predicated on suspected or proven contributors. Historically, reported medical treatment options have included oral, topical, and intravenous anti-infective agents, oral and topical anti-inflammatories, treatment of comorbid allergic disease, and perioperative debridement. This chapter is a summary of selected medical treatment regimen with a presentation of available evidence. The use of oral antibiotics not exceeding three weeks has been shown to be beneficial in CRS exacerbations. Macrolides and doxycycline have been reported to have anti-inflammatory properties in addition to their antibacterial properties. Although widely practiced among sinus surgeons, original research on postoperative antibiotics produced mixed results and depends on surgeon preference. There is no proven role for intravenous antibiotics, topical antifungals, and oral antifungals in any phase of noninvasive CRS management. Topical steroids are beneficial as mainstay medical treatment in preoperative and postoperative care. There is some evidence supporting short perioperative course of oral steroids, but there is no strong evidence available to suggest doses higher than 30 mg 5–7 days preoperatively. Patients with allergic contributors may benefit from a wide variety of agents including oral and topical antihistamines and postoperative immunotherapy. In addition, patients with aspirin-exacerbated airway disease (AERD) who receive postoperative aspirin desensitization have better outcomes than cohorts who do not receive aspirin desensitization. There is great promise in the use of anti-IgE antibody omalizumab in the treatment of CRS patients with nasal polyposis and asthma. This should be considered in the treatment of applicable patients if available.

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Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 15-200, Chicago, IL, 60611, USA

    Opeyemi O. Daramola MD

  2. Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University School of Medicine, 1215 21st Ave. South Suite 7209 Medical Center East, South Tower, Nashville, TN, 37232, USA

    Rakesh K. Chandra MD

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  1. Opeyemi O. Daramola MD
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Correspondence to Rakesh K. Chandra MD .

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Editors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Pete S. Batra

  2. Department of Otolaryngology and Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA

    Joseph K. Han

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Daramola, O.O., Chandra, R.K. (2015). Medical Therapy in the Preoperative and Postoperative Period. In: Batra, P., Han, J. (eds) Practical Medical and Surgical Management of Chronic Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-319-16724-4_23

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