Treatment of rhinosinusitis
The aim of rhinosinusitis treatment is to reduce sinonasal inflammation, eliminate the underlying cause, decrease the number of flare-ups, and maintain the nasal cavities unobstructed.
The initial treatment depends on the severity of the disease. If it is mild, management starts with symptomatic treatment (decongestants, saline solution, painkillers). In moderate cases, intranasal topical corticosteroids are administered, and in severe or bacterial cases, antibiotics, intranasal topical corticosteroids, and oral corticosteroids are used.
Non-drug therapy
Nasal irrigation with physiological saline and hypertonic saline solution. To alleviate symptoms by flushing any retained mucus; used for both acute and chronic rhinosinusitis.
Drug therapy
Including the following treatments, amongst others:
Nasal corticosteroids. These are nasal aerosol sprays with anti-inflammatory effect. They have a very low absorption in blood, so their effect only acts on the nose. Some examples are fluticasone o mometasone.
Oral corticosteroids. These medications are used to reduce the inflammation in severe rhinosinusitis, especially in patients who also have polyps. Oral corticosteroids can produce mid side effects when used for prolonged periods, so they are only used to treat severe symptoms.
Antibiotics. Rhinosinusitis must occasionally be treated with antibiotics, above all in cases of acute bacterial rhinosinusitis.
Nasal decongestants. These can be used for short periods (5-7 days) in the treatment of acute rhinosinusitis in order to decrease nasal congestion and improve sinus ventilation and drainage paranasal. There is no evidence that they are effective against chronic rhinosinusitis.
Immunotherapy. If allergies aggravate the rhinosinusitis, injectable or sublingual allergy vaccinations (immunotherapy) help reduce the body’s reaction to specific allergens.
Surgical treatment
Nasal and sinus surgery is indicated for patients with chronic rhinosinusitis who, despite following appropriate medical treatment, do not achieve good symptom control. Currently, surgery is performed under general anesthesia and through an endoscopic approach, meaning it is done using an endoscope with a camera and light at the tip, allowing work inside the nose without the need for external incisions.
Nasal and sinus surgery is personalized for each case and tailored to the extent of the disease. The sinuses that are blocked by mucus and/or nasal polyps are opened, and polyps are removed if necessary.
New therapies
The biological drugs currently being studied for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) are monoclonal antibodies that mainly act by interfering at different stages of the inflammatory response.
By mid-2025 in Spain, only three biologic drugs were indicated for the treatment of chronic rhinosinusitis with nasal polyps: dupilumab, omalizumab and mepolizumab. Both dupilumab and mepolizumab have their costs reimbursed by the National Health System. Other new drugs, such as tezepelumab and depemokimab, have completed and published phase III trials and are pending approval and reimbursement for the indication of severe chronic rhinosinusitis with nasal polyps.
Treatment complications
Nasal irrigation. Nasal dryness and irritation. Other rare side effects are nausea secondary to irrigation, burning, cough, dizziness and tearing.
Nasal corticosteroids. Mainly nasal dryness and irritation, and minor nosebleeds (microepistaxis), especially when an improper technique is used.
Oral corticosteroids. Oral corticosteroids long-term use can have effects on the patient’s metabolism such as weight gain, osteoporosis, retarded growth, skin atrophy, diabetes, high blood pressure, cataracts, etc., and therefore the minimum effective dose must be administered for the least amount of time possible.
Antibiotics. Among the most common side effects of antibiotics are dizziness, diarrhea, and, in women, yeast (fungal) vaginal infections. Some reactions may be more severe and, depending on the antibiotic, can affect liver and kidney function. Antibiotics can also cause allergic reactions, which are usually mild and consist of redness and itching. At a population level, another important consequence of treatment is the development of resistance due to excessive and/or inappropriate use of antibiotics. Antibiotic resistance is a major public health problem, and there is increasing agreement that antibiotic use is the main factor creating the selective pressure responsible for this resistance.
Nasal decongestants. The most common adverse effect associated with the topical administration of nasal decongestants is the reappearance of nasal congestion (rebound) in patients who have used these agents over extended periods (more than a week) or used them abusively. This effect comes about after using the medication for between 5 and 7 days.
Surgical complications. Aspects that give rise to complications are the large degree of anatomical variability in this region, and the proximity to the brain and eyes.
Substantiated information by:
Published: 19 September 2018
Updated: 21 October 2025
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