Intended for healthcare professionals

Practice 10-Minute Consultation

Chronic rhinosinusitis

BMJ 2019; 364 doi: (Published 06 February 2019) Cite this as: BMJ 2019;364:l131
  1. Alison Carter, speciality registrar in otorhinolaryngology1,
  2. Nikesh Dattani, GP partner and governing board GP, clinical lead Barnet Clinical Commissioning Group2,
  3. Saiful Alam Hannan, consultant otorhinolaryngologist, head and neck surgeon1
  1. 1Royal National Throat Nose and Ear Hospital, London, UK
  2. 2Millway Medical Practice, London
  1. Correspondence to: A Carter alicarter{at}

What you need to know

  • First line treatment options for chronic rhinosinusitis are intranasal corticosteroids and intranasal saline rinsing, usually in combination

  • Persistent use of over-the-counter topical nasal decongestant causes rebound nasal congestion, known as rhinitis medicamentosa

  • Sinus surgery is not a curative treatment, but is aimed at unblocking sinonasal pathways and spaces to allow topical nasal medication to be more effective

A 35 year old hairdresser presents to her general practitioner with a two year history of a blocked and runny nose. When she tried using an over-the-counter beclomethasone nasal spray, she did not notice any improvement. As she cannot breathe through her nose, she finds it hard to get to sleep and to exercise.

Chronic rhinosinusitis is a common condition with a prevalence of 10.9%.1 It can have a major impact on quality of life, affecting sleep, exercise, and activity. Intranasal treatments are effective for most people2 but need to be used correctly and regularly. This article offers an evidence based approach to diagnosis and management.

What you should cover

Aim to determine any precipitating factors or associated disease, and differentiate between structural and inflammatory nasal blockage (although both can be present). Try to establish the effect that symptoms are having on quality of life to help direct joint decision making and stepwise treatment. Acknowledging this impact can be useful in the consultation, as patients often feel embarrassed for seeking healthcare for a chronically blocked or runny nose, as they worry that such symptoms may be perceived as trivial.

  • Is the nasal blockage unilateral, alternating or bilateral? Unilateral blockage is a structural problem, such as a congenital or post-traumatic septal deviation, polyp, or tumour. Referral for nasal endoscopy is indicated if …

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