• Sinonasal polyposis with nasal airway obstruction or suboptimal asthma control
  • Chronic rhinosinusitis  with persistent symptoms and objective evidence of disease by endoscopic and/or CT imaging that is refractory to maximal medical treatment
  • Allergic fungal rhinosinusitis
  • Mucocele
  • Recurrent acute rhinosinusitis (RARS)
  • Unilateral paranasal sinus opacification, symptomatic or asymptomatic, consistent with chronic sinusitis, fungus ball, benign neoplasm (i.e, inverted papilloma), etc.
  • Complications of sinusitis, including extension to adjacent structures (i.e. face, orbit, skull base)

Physical Examination 

  • Complete anterior and posterior nasal examination (rhinoscopy after mucosal decongestion)
  • Examination of nasopharynx 
  • Nasal endoscopy
  • Dental, neurologic, ophthalmologic, and/or pulmonary evaluation may be required in cases of extrasinus involvement


Note: Imaging studies should be generally obtained after maximal medical therapy. Based on clinical

situation (i.e. concern for extrasinus complications or neoplasm), early or emergent imaging may be 

required to confirm a diagnosis. 

  • Coronal CT scan (minimum 3 mm slice thickness, bone algorithm) is the preferred imaging study
  • Navigation sinus CT in those cases for which surgical navigation is planned
  • Sinus MRI with/without contrast for cases with skull base and orbital erosion (on CT imaging), possible neoplasm, AFRS and/or mucocele with orbit and skull base erosion.
  • Endoscopically directed cultures in select cases
  • Allergy testing (if symptoms are consistent with allergic rhinitis and non- or under-responsive to pharmacotherapy, eg, antihistamines, intranasal corticosteroids, etc.)
  • Peripheral eosinophil count, total IgE level, or other laboratory studies may be required at the discretion of the physician.
  • Immunodeficiency evaluation at the discretion of the physician.

Maximal Medical Therapy: 

  • Oral antibiotics of 2-4 weeks duration for patients with CRS (culture-directed if possible)
  • Oral antibiotics with multiple 1-3 week courses for patients with RARS
  • Systemic and/or topical steroids (at the discretion of the physician)
  • Saline irrigations (optional)
  • Topical and/or systemic decongestants (optional, if not contraindicated)
  • Treatment of concomitant allergic rhinitis, including avoidance measures, pharmacotherapy, and/or immunotherapy (at the discretion of the physician)

Postoperative Observations 

  • monitor for excessive bleeding; if present, notify surgeon
  • monitor for excessive headache/pain; if present, notify surgeon
  • monitor for blurry vision, double vision, eye swelling, etc.; if present, notify surgeon. 
  • monitor for mental status changes; if present, notify surgeon

Postoperative care

  • Endoscopy for debridement and assessment as clinically warranted2
  • Monitor for CSF leak and vision changes
  • Endoscopic-guided cultures for exacerbations
  • Additional medical therapy, including but not limited to topical nasal steroids, saline irrigations, and topical antibiotics and/or steroids
  • Coordination of care with other physicians, including PCP, allergist and pulmonologist as warranted

    Outcome Review 

    • Assess for the following:
      • Improvement in symptoms ascribed to CRS
      • Status of paranasal sinus mucosa
      • Assess of complications, including CSF leak
      • Status of concomitant asthma