[Medical and surgical treatment options in the management of upper airway diseases].Ther Umsch. 2008 Mar; 65(3):175-80.TU
Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (acute and chronic, with and without nasal polyps) is defined as an inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage, obstruction, congestion or nasal discharge (anterior and posterior nasal drip). For the acute rhinosinusitis one can state that the initial antibiotic treatment does not affect the outcome of the disease, therefore a symptomatic treatment as first line is adequate. Antibiotics are indicated after a prolonged phase of the disease with increase of the symptoms mainly after a period up to 10 days. An early treatment with topical steroids is most efficient in ARS. Chronic rhinosinusitis (CRS) is a multifactorial disease. Factors contributing can be mucociliary impairment, bacterial infection, allergy, swelling of the mucosa for another reason or anatomical variations in the nasal cavity. The ostiomeatal complex, a functional unit of the paranasal sinuses plays a key role in the pathogenesis of rhinosinusitis. The first line treatment strategy is medical treatment using topical steroids, long-term macrolide therapy and in severe cases short courses of systemic steroids. The role of surgery is defined to treat the residual disease after medical treatment. Surgery is primarily aimed at improving ventilation of the sinuses and restoring paranasal clearance.