# Chronic Rhinosinusitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ · EPOS 2020 - European Position Paper on Rhinosinusitis and Nasal Polyps, executive summary, adult chronic rhinosinusitis treatment table (epos-2020-executive-summary.pdf) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over - Verified date: 2026-08 ## Verified against - Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ - EPOS 2020 - European Position Paper on Rhinosinusitis and Nasal Polyps, executive summary, adult chronic rhinosinusitis treatment table (epos-2020-executive-summary.pdf) - Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over ## Treatment metadata - Fluticasone propionate — spray - Sodium chloride 0.9% — spray ## Complete treatment card ```text CHRONIC RHINOSINUSITIS Sources: Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ · EPOS 2020 - European Position Paper on Rhinosinusitis and Nasal Polyps, executive summary, adult chronic rhinosinusitis treatment table (epos-2020-executive-summary.pdf) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - Builds over months to years and is often missed, because there is usually neither pain nor fever - Needs 12 weeks or more of symptoms, and at least two of the four cardinal ones - Thick or discoloured discharge, running forwards, backwards or both - A blocked nose [blocked nose] - Pain, pressure or fullness in the face - A dulled sense of smell - Quieter clues: drip down the back of the throat, headache, a dry cough that will not settle, sore throat [cough · headache · sore throat] - In children the persistent dry cough is a particularly common clue [cough] - Also bad breath, malaise, poor appetite, sneezing, and altered taste [malaise · poor appetite · sneezing · taste disturbance] - Also blurred vision, blocked or dulled hearing, dizziness, and fever [blurred vision · dizziness · fever] - Ask about past allergic, immune or metabolic disease, and about surgery, injury and family history SIGNS - what you find (9) - Press over the sinuses for tenderness or swelling - Shining a light through cheek or forehead sinuses adds little - Looking up the front of the nose shows only so much; a topical decongestant improves the view - Examine the eyes for restricted movement or a nerve palsy, and for blurred vision [blurred vision · paralysis · reduced range of movement] - Check the conjunctiva, tear flow, and whether the eye is sunken or pushed forward - Fluid behind the eardrum can mean a mass or blockage in the nasopharynx - In the mouth look for drip from behind, palate defects or nasopharyngeal masses, and dental disease - Fibreoptic laryngoscopy looks for reflux reaching the larynx and throat [heartburn] - Examine the chest for disease of the upper and lower airway, and test the cranial nerves TESTS (12) - Nasal endoscopy sees the mucosa, septum and turbinates front to back and reaches the osteomeatal complex - Endoscopy also lets you culture pus and look for blockage or polyps - Routine bloods add little unless the history points to another disease - Allergy and immune tests support the diagnosis rather than make it - Allergy testing by radioallergosorbent assay or skin prick - Serum immunoglobulins with IgG subclasses; total IgE where allergic fungal sinusitis is suspected; HIV test - Plain films add little: they may show thickened lining or a white sinus, but are neither sensitive nor specific - A fluid level is rarely seen in the chronic disease - Contrast CT in several planes is the reference test, showing opaque sinuses or thickened lining - CT also finds polyps, mucoceles, blocked drainage channels, tumours and bone erosion or sclerosis - MRI is better for soft tissue and adds to CT for tumours, orbital or brain spread, and fungal disease - A nasal swab culture is worth little; endoscopic middle meatus culture is 81% sensitive and 91% specific IF NOT THIS - what else fits (12) - Recurrent acute sinusitis, or a single acute bacterial attack - Viral upper respiratory infection - Rhinitis, whether allergic or not - Facial neuralgia - Migraine or another primary headache disorder - Dental infection or a periodontal abscess - Tumour of the nose or sinuses - Inverting papilloma - Sensitivity to aspirin and other anti-inflammatory painkillers - A foreign body in the nose - Fungal sinusitis - Juvenile nasopharyngeal angiofibroma, or cystic fibrosis Source StatPearls "Chronic Sinusitis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Alongside the steroid MAIN TREATMENT 1. FLUTICASONE PROPIONATE [1st line] Adult 2 sprays (100 mcg) into EACH nostril once daily - long-term, reassess at 12 weeks Peds 4 to 12 years: One spray into each nostril once daily (Children 4-12 years: one spray into each nostril once daily per the Egyptian formulary. Chronic rhinosinusitis in a child warrants ENT assessment rather than open-ended treatment in primary care.) Source Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over Why An intranasal corticosteroid is the foundation of chronic rhinosinusitis treatment. StatPearls puts saline and a nasal steroid together as the pair most people gain from when they are used steadily. The dose is the Egyptian formulary's standard adult intranasal one, not a higher one: in acute sinusitis NICE recommends a high dose for 14 days, but this is continuous treatment and no document held here recommends a high dose for it. Caution TWELVE WEEKS is the diagnosis, not a long cold. StatPearls asks for symptoms lasting 12 weeks or more, plus two or more of: thick or discoloured drainage, nasal congestion, facial pain or pressure, reduced sense of smell - AND objective evidence of mucosal disease on endoscopy or CT. This is NOT acute sinusitis and is not treated with a course of antibiotics. If you are reaching for amoxicillin-clavulanate, re-read the duration. Off-label on the Egyptian label, which indicates the nasal spray for allergic rhinitis. The indication in chronic rhinosinusitis is from the guideline, not the product licence. It works slowly. Judge it at 8-12 weeks of CONSISTENT use, not after two weeks - most failures are adherence, not drug failure. Unilateral symptoms, bleeding, facial numbness or orbital signs are not chronic rhinosinusitis. Refer. Objective confirmation (endoscopy or CT) is part of the definition - a diagnosis made on symptoms alone will include a lot of allergic rhinitis and some nasal polyps. Egypt RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE ARAB DRUG COMPANY (ADCO) 32.00 EGP TICANASE 0.05% NASAL SPRAY 12 GM EUROPEAN EGYP... 70.00 EGP FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE EVA PHARMA 76.00 EGP FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE GLAXO SMITHKLINE 133.00 EGP FLOHALE HFA 250MCG/DOSE AEROSOL 120 DOSES CIPLA LTD. - INDIA > STAR INTE... 95.00 EGP ALONGSIDE THE STEROID - give alongside 2. SODIUM CHLORIDE 0.9% [add-on - not a substitute] Adult Nasal saline irrigation or spray, each nostril, once or twice daily. Use BEFORE the steroid spray so it is not washed straight out. - long-term Peds Safe in children and often the only thing they will tolerate. Use an age-appropriate device. Source Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ Why EPOS 2020 advises nasal saline irrigation for adult chronic rhinosinusitis. Its finding is that rinsing with isotonic saline, or with Ringer's lactate, works in these patients, and that the evidence is too thin to establish a large volume as better than a nasal spray. StatPearls pairs the rinse with the steroid, as the two things most people gain from using steadily. Neither document gives a frequency, so the once-or-twice-daily figure and the saline-before-steroid order are flagged in the cautions below as practice convention rather than sourced guidance - the card must not read as though either document said them. Caution Order matters: saline first, then the steroid. Isotonic saline or Ringer's lactate, not hypertonic. EPOS 2020 backs nasal saline irrigation using isotonic saline or Ringer's lactate, while advising against baby shampoo and against hypertonic saline. A spray is not inferior to high-volume irrigation on the evidence EPOS reviewed. Irrigation must use boiled-and-cooled or distilled water, never untreated tap water. This relieves symptoms; it does not treat the underlying mucosal disease on its own. The once-or-twice-daily frequency and the saline-before-steroid order are common practice, not statements taken from either document cited here. EPOS 2020 gives no frequency for saline and no sequence relative to the steroid; StatPearls gives neither either. Both are reasonable and neither is unsafe - they are simply not sourced, and are marked so rather than dressed as guidance. Egypt RHINO-MARINE PEDIATRIC NASAL SPRAY 60 ML SEKEM 32.00 EGP FREE NOSE NASAL SPRAY 30 ML (0-6 YEARS) PHARMALINK S.L. > AUG PHARMA 75.00 EGP FREE NOSE NASAL SPRAY 30 ML (6+ YEARS) PHARMALINK S.L. > AUG PHARMA 75.00 EGP SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML > SOFICOPHARM 170.00 EGP PHYSIOMER NORMAL JET NASAL SPRAY 135ML LABORATOIRE DE LA MER > STAR INTE... 300.00 EGP EAU DE MER ISOTONIC NASAL SPRAY 30% 100ML > SANDOZ 350.00 EGP MARIMER ISOTONIC NASAL SPRAY 100ML LABORATOIRES GILBERT - FRANCE > UNITE... 385.00 EGP PHYSIOMER BABY MIST NASAL SPRAY 115ML LABORATOIRE DE LA MER > STAR INTER... 400.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)