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Chronic Rhinosinusitis
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Treatment of CRS is primarily medical. Saline nasal irrigation is safe and effective and may be well tolerated by some children. The evidence base for most pharmacological interventions in children is weak, but INCSs are usually recommended, certainly before contemplating any surgical treatment. EPOS guidelines recommend that surgery should only be considered following ‘appropriate medical treatment’ (AMT), and despite the poor evidence base to support the use of antibiotics, most ORL specialists will recommend a course of antibiotics before considering surgery.
Extrapulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Intranasal glucocorticoids (nCS) and oral/topical antihistamines are the most effective treatments for the symptoms of allergic rhino-conjunctivitis and should be the first-line therapy for mild to moderate disease. In moderate to severe disease that does not respond well to nCS, additional pharmacological therapies with cromolyn and leukotriene receptor antagonists are necessary. Allergen immunotherapy and non-pharmacological treatment with nasal irrigation are additional options. Regarding the use of oral steroids, the current documentation is limited as few studies are available; however, oral steroids seem to bring about a significant dose-dependent reduction in symptoms despite the differences between symptoms. Furthermore, one study has supported injection with steroids over oral treatment. Anyhow, the use of systemic steroids is strongly discouraged due to the substantial side effects. If needed, short courses are recommended and only in rare cases, with large respect to side effects when used for maintenance treatment.
Sinusitis (Acute)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Symptom Relief: Topically or orally administered decongestants, proteolytic enzymes, nasal irrigation with salt water, mucolytic agents, and antihistamines have all been used for symptom relief in acute bacterial sinusitis.2
Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease
Published in British Journal of Neurosurgery, 2020
Lisa Caulley, Ravindra Uppaluri, Ian F. Dunn
Patient education and regular patient visits are key to ensuring maximal sinonasal health in the post-operative period. Follow-up should be coordinated between the neurosurgery and otolaryngology teams to achieve adequate continuity of care. The timing of follow-up is dependent on nasal packing post-operatively, nasal irrigation, degree of nasal crusting, and extent and frequency of debridement. Nasal crusting is the most common postoperative symptoms following skull base surgery, with a median time to absence of crusting of 101.0 days.51 Routine nasal saline rinses are recommended to reduce accumulation of nasal debris and facilitate healing (Figure 3). Nasal irrigations should be initiated 72 h post-operatively, after nasal packing is removed, for passive debridement of nasal crusting and discharge. Active debridement can be initiated between post-operative day 7 and 14 in order to reduce accumulation of nasal debris. Frequency of postoperative visits by otolaryngology is dictated by degree of nasal crusting and frequency of nasal irrigations but should typically be continued on a monthly basis. Effective nasal irrigation can decrease the necessity for in-office debridements. Patients should continue nasal irrigation and routine debridement until satisfactory healing is observed.
Efficacy of hypertonic (2.3%) sea water in patients with aspirin-induced chronic rhinosinusitis following endoscopic sinus surgery
Published in Acta Oto-Laryngologica, 2019
Aleksandar Perić, Sandra Vezmar Kovačević, Aleksandra Barać, Dejan Gaćeša, Aneta V. Perić, Svjetlana Matković Jožin
The use of different solutions for nasal irrigation is recommended after ESS as inexpensive and effective treatment for improving nasal symptoms and local finding [7,11–18]. Nasal douching can be easily used at home and has relatively small potential for adverse events compared to other conservative treatment modalities. During postoperative care, nasal irrigation can be useful method to minimize crust formation, decrease viscosity of the thick mucus by humidifying the nasal cavity, minimize postoperative infections, promote mucosal regeneration and improve nasal breathing [7,13]. This postoperative care is important especially in patients suffering from AERD where it is necessary to administer nasal corticosteroid sprays or drops immediately after the nasal douching [3–5].
Current and emerging pharmacotherapy for pediatric allergic rhinitis
Published in Expert Opinion on Pharmacotherapy, 2021
Peter Valentin Tomazic, Doris Lang-Loidolt
In their meta-analysis, Head et al. [31] state that nasal irrigation in children is beneficial compared to no irrigation. There is not enough evidence that adding nasal douching onto standard therapies like nasals steroids and/or antihistamine would improve their effect and there is not enough evidence whether saline is better, same or worse than other topical treatment. Madison et al. [32] conclude that saline is a useful adjunct but is not more effective than intranasal steroids It is clear, however, that it is not harmful. The majority of children (>78%) would tolerate the treatment [33]. (Buffered) hypertonic saline seems to work better than normal saline solution [34] and additionally seems to reduce nasal eosinophils and neutrophils [35].