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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.


  • 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


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)