Chronic rhinosinusitis is defined by two or more of: nasal obstruction, mucopurulent discharge, decreased sense
of smell or facial pain, along with CT or endoscopic evidence of sinus disease. Consider differential
diagnoses according to symptoms; they include allergic rhinitis, headache syndromes such as migraine,
laryngopharyngeal reflux and globus pharyngeus. Once the diagnosis is made, commence a trial of maximal
medical management. If the patient does not respond to maximal medical management then referral to an
ear, nose and throat specialist is warranted for further investigation and medical and possibly surgical
management. Removal of the adenoids is often helpful in children with chronic rhinosinusitis.
Modern Medicine – April 2018