Chronic Rhinosinusitis When Intranasal Corticosteroid Spray and Saline Irrigation Have Not Achieved Clinical Improvement

This protocol addresses patients with chronic rhinosinusitis in whom the recommended first-line medical regimen has been completed but has not produced the expected clinical response.

Prior Treatment & Failure Condition

First-line therapy — an intranasal corticosteroid spray (mometasone furoate or fluticasone furoate) combined with nasal saline irrigation, used for a minimum of 8 weeks — did not result in meaningful reduction in nasal blockage, rhinorrhea, or nasal polyp size. Failure to reach those goals indicates escalation to the next management step.

Next-Line Approach

When standard medical therapy has not been beneficial, a surgical intervention targeting the sinuses is an established and effective option at this stage. The full protocol specifies the complete criteria, pathway, and regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1503/cmaj.241101

Endoscopic sinus surgery is known to be an effective and safe treatment for patients with chronic rhinosinusitis for whom standard medical therapy has not been beneficial.

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