A Practical Approach to Refractory Chronic Rhinosinusitis

Otolaryngol Clin North Am. 2017 Feb;50(1):183-198. doi: 10.1016/j.otc.2016.08.014.


Patients with refractory chronic rhinosinusitis, by definition, have persistent, poorly controlled symptoms and objective inflammatory findings despite prior medical and surgical therapy. These patients represent a diagnostic and treatment challenge given the complexity of the underlying disease factors and the limitations in available management options. This article presents a practical framework for clinical evaluation and treatment. Germane to discussion are emerging concepts in refractory chronic rhinosinusitis that will likely have important implications in the near future.

Keywords: Chronic rhinosinusitis; Nasal polyps; Sinus surgery; Topical therapy.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Disease Management
  • Humans
  • Nasal Polyps / diagnosis
  • Nasal Polyps / physiopathology
  • Nasal Polyps / therapy
  • Rhinitis* / diagnosis
  • Rhinitis* / physiopathology
  • Rhinitis* / therapy
  • Sinusitis* / diagnosis
  • Sinusitis* / physiopathology
  • Sinusitis* / therapy
  • Treatment Failure