Chronic rhinosinusitis

This is defined as chronic inflammation of the nose and sinuses for at least 12 weeks. Whilst there are a number of different factors involved in this common condition, such as environmental factors (allergy and pollution) and individual anatomy and past surgery, GORD is a recognised factor in its aetiology.

Symptoms

• Nasal obstruction, stuffiness and congestion
• Nasal discharge
• Post-nasal drip
• Facial fullness, headache, pressure
• Loss of sense of smell
• Poor sleep
• Halitosis
• Chronic cough
• Sore throat
• Sneezing

Treatment

The aim is to reduce mucosal swelling, encourage sinus drainage and clear any concurrent infection.

1. Symptomatic treatment – steam inhalation and nasal saline irrigation.
2. Control of predisposing factors – reduction of exposure to environmental irritants like dust, mould, cigarette smoke.
3. Management of GORD.
4. Management of asthma if co-existent – leukotriene inhibitors may be helpful here such as montelukast, 10mg nocte.
5. Topical steroid spray, eg mometasone or fluticasone for up to three months.
6. Sodium cromoglycate drops or spray – one spray two to four times per day.
7. Oral steroids may occasionally be necessary.
8. Surgery and ENT referral may be considered in refractory cases. (113)