What Is the First-Line Treatment for Chronic Rhinosinusitis?

Chronic rhinosinusitis is a persistent inflammatory condition of the sinuses and nasal passages. Managing it effectively requires a structured, evidence-based approach targeting the underlying mucosal inflammation and relieving the burden of symptoms.

Clinical Goals

The primary aims of first-line management are:

Reducing nasal blockage and rhinorrhea
Decreasing inflammation in the sinonasal mucosa
Reducing nasal polyp size where present

First-Line Approach

First-line management centres on long-term topical nasal therapy, combining an intranasal corticosteroid with nasal saline irrigation. The sequence in which these are applied matters for treatment effectiveness.

The complete regimen — including the specific agents, dosing schedule, and minimum treatment duration — is detailed in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1503/cmaj.241101

First-line treatments include the long-term use of topical saline and intranasal corticosteroids.
Long-term topical intranasal corticosteroids are the first-line treatment.
Regardless of the delivery method, irrigation should be done before using an intranasal steroid spray to avoid washing out the medication.
Intranasal corticosteroids improved patient symptoms, reduced inflammation in the sinonasal mucosa (including the reduction of nasal polyps), and addressed related conditions such as allergic rhinitis.

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