Skip to main content
SpringerLink
Log in
Book cover

Frontal Sinus Surgery pp 401–409Cite as

Optimal Strategies in Medical Management of Frontal Sinusitis

  • Chapter
  • First Online:

  • 630 Accesses

Abstract

Chronic rhinosinusitis (CRS) is an inflammatory condition of the sinonasal passages. Medical therapy is an essential component in the management of CRS and is often necessary for successful long-term symptom control and the control of disease recurrence. The primary goal of medical therapy is to reduce sinonasal mucosal inflammation. The frontal sinus is the most complex sinus to manage in patients with CRS, in part due to its challenging anatomy and difficulty of delivering topical anti-inflammatory medications through the frontal recess due the presence of variable and complex frontal cells, which may partially or completely obstruct the frontal recess. While endoscopic sinus surgery (ESS) may improve the delivery of medication to the frontal recess, stenosis and disease recurrence are common, and prolonged medical therapy is often required. A variety of medical therapies are currently available for the management of CRS, and many innovative therapies are currently being investigated. Understanding the different types of therapies available, as well as the evidence and role for these therapies, is essential to aid clinicians in managing frontal sinusitis. The objective of this chapter is to review the available medical therapies, the most up-to-date evidence for these therapies, and their role in the management of frontal sinusitis.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1–12.

    Article  Google Scholar 

  2. Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: a systematic review. JAMA. 2015;314(9):926–39.

    Article  CAS  Google Scholar 

  3. Lee WT, Kuhn FA, Citardi MJ. 3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis. Otolaryngol Head Neck Surg. 2004;131(3):164–73.

    Article  Google Scholar 

  4. Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl 1):S22–209.

    PubMed  Google Scholar 

  5. DeConde AS, Smith TL. Outcomes after frontal sinus surgery: an evidence-based review. Otolaryngol Clin N Am. 2016;49(4):1019–33.

    Article  Google Scholar 

  6. Kalish L, Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. Topical steroids for nasal polyps. Cochrane Database Syst Rev. 2012;12:CD006549.

    PubMed  Google Scholar 

  7. Snidvongs K, Kalish L, Sacks R, Craig JC, Harvey RJ. Topical steroid for chronic rhinosinusitis without polyps. Cochrane Database Syst Rev. 2011(8):CD009274.

    Google Scholar 

  8. Kerr EA, Hayward RA. Patient-centered performance management: enhancing value for patients and health care systems. JAMA. 2013;310(2):137–8.

    Article  CAS  Google Scholar 

  9. Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G, et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011995.

    PubMed  Google Scholar 

  10. Chong LY, Head K, Hopkins C, Philpott C, Schilder AG, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011996.

    PubMed  Google Scholar 

  11. Thomas WW 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ. Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3(9):691–703.

    Article  Google Scholar 

  12. Rudmik L, Soler ZM, Hopkins C, Schlosser RJ, Peters A, White AA, et al. Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study. Int Forum Allergy Rhinol. 2016;6(6):557–67.

    Article  Google Scholar 

  13. Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(3):228–32.

    Article  Google Scholar 

  14. Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol. 2018;8(4):461–70.

    Article  Google Scholar 

  15. Smith KA, Rudmik L. Delivery of topical therapies. In: Woodworth BA, Poetker DM, Reh DD, editors. Advances in oto-rhino-laryngology – Rhinosinusitis with nasal polyposis. Basel/New York: Karger; 2016.

    Google Scholar 

  16. Fokkens WJ, Ebbens F, van Drunen CM. Fungus: a role in pathophysiology of chronic rhinosinusitis, disease modifier, a treatment target, or no role at all? Immunol Allergy Clin N Am. 2009;29(4):677–88.

    Article  Google Scholar 

  17. Schwartz JS, Tajudeen BA, Cohen NA. Medical management of chronic rhinosinusitis – an update. Expert Rev Clin Pharmacol. 2016;9(5):695–704.

    Article  CAS  Google Scholar 

  18. Lee JT, Chiu AG. Topical anti-infective sinonasal irrigations: update and literature review. Am J Rhinol Allergy. 2014;28(1):29–38.

    Article  Google Scholar 

  19. Barham HP, Ramakrishnan VR, Knisely A, Do TQ, Chan LS, Gunaratne DA, et al. Frontal sinus surgery and sinus distribution of nasal irrigation. Int Forum Allergy Rhinol. 2016;6(3):238–42.

    Article  Google Scholar 

  20. Singhal D, Weitzel EK, Lin E, Feldt B, Kriete B, McMains KC, et al. Effect of head position and surgical dissection on sinus irrigant penetration in cadavers. Laryngoscope. 2010;120(12):2528–31.

    Article  Google Scholar 

  21. Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. 2011;154(5):293–302.

    Article  Google Scholar 

  22. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AG. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011991.

    PubMed  Google Scholar 

  23. Hong CJ, Tsang AC, Quinn JG, Bonaparte JP, Stevens A, Kilty SJ. Anti-IgE monoclonal antibody therapy for the treatment of chronic rhinosinusitis: a systematic review. Syst Rev. 2015;4:166.

    Article  Google Scholar 

  24. Chang TW, Shiung YY. Anti-IgE as a mast cell-stabilizing therapeutic agent. J Allergy Clin Immunol. 2006;117(6):1203–12; quiz 13

    Article  CAS  Google Scholar 

  25. Para AJ, Clayton E, Peters AT. Management of rhinosinusitis: an evidence based approach. Curr Opin Allergy Clin Immunol. 2016;16(4):383–9.

    Article  CAS  Google Scholar 

  26. Pinto JM, Mehta N, DiTineo M, Wang J, Baroody FM, Naclerio RM. A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis. Rhinology. 2010;48(3):318–24.

    CAS  PubMed  Google Scholar 

  27. Gevaert P, Lang-Loidolt D, Lackner A, Stammberger H, Staudinger H, Van Zele T, et al. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol. 2006;118(5):1133–41.

    Article  CAS  Google Scholar 

  28. Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F, et al. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol. 2011;128(5):989–95, e1–8

    Article  CAS  Google Scholar 

  29. Gandhi NA, Bennett BL, Graham NM, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35–50.

    Article  CAS  Google Scholar 

  30. Akdis CA, Bachert C, Cingi C, Dykewicz MS, Hellings PW, Naclerio RM, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European academy of allergy and clinical immunology and the American academy of allergy, asthma & immunology. J Allergy Clin Immunol. 2013;131(6):1479–90.

    Article  Google Scholar 

  31. Bachert C, Zhang N, Holtappels G, De Lobel L, van Cauwenberge P, Liu S, et al. Presence of IL-5 protein and IgE antibodies to staphylococcal enterotoxins in nasal polyps is associated with comorbid asthma. J Allergy Clin Immunol. 2010;126(5):962–8, 8.e1–6

    Article  CAS  Google Scholar 

  32. Bachert C, van Steen K, Zhang N, Holtappels G, Cattaert T, Maus B, et al. Specific IgE against Staphylococcus aureus enterotoxins: an independent risk factor for asthma. J Allergy Clin Immunol. 2012;130(2):376–81.e8.

    Article  CAS  Google Scholar 

  33. Bachert C, Mannent L, Naclerio RM, Mullol J, Ferguson BJ, Gevaert P, et al. Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial. JAMA. 2016;315(5):469–79.

    Article  CAS  Google Scholar 

  34. Rudmik L, Soler ZM, Hopkins C, Schlosser RJ, Peters A, White AA, et al. Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study. Rhinology. 2016;54(2):117–28.

    Article  Google Scholar 

  35. Sohal M, Tessema B, Brown SM. Medical management of frontal sinusitis. Otolaryngol Clin N Am. 2016;49(4):927–34.

    Article  Google Scholar 

  36. Santarelli GD, Han JK. Evaluation of the PROPEL(R) mini sinus implant for the treatment of frontal sinus disease. Expert Opin Drug Deliv. 2016;13(12):1789–93.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, USA

    Kristine A. Smith

  2. Division of Otolaryngology – Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA

    Jeremiah A. Alt & Richard R. Orlandi

Authors
  1. Kristine A. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremiah A. Alt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard R. Orlandi
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Prof of Otolaryngology, Mayo Clinic College of Medicine and Science, Associate Dean, Mayo Clinic School of Continuous Professional Development, Consultant, Dept of Otolaryngology-Head and Neck Surgery, Consultant (Joint), Dept of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA

    Devyani Lal

  2. Professor and Chief, Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Peter H. Hwang

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Smith, K.A., Alt, J.A., Orlandi, R.R. (2019). Optimal Strategies in Medical Management of Frontal Sinusitis. In: Lal, D., Hwang, P. (eds) Frontal Sinus Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-97022-6_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97022-6_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97021-9

  • Online ISBN: 978-3-319-97022-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation