There are many ways to manage CRS. Maintenance treatments focus on reducing inflammation and irritation, clearing mucus, and improving breathing through the nose.
One of the key therapies for CRS is nasal rinsing with saline (salt water). This simple solution can:
Using a rinse before applying other medications to your nose (like corticosteroid sprays) can also help those medicines work better by allowing them to reach the inside of your nose more effectively.
Nasal rinsing with saline has few side effects, except that you need to learn how to do it properly to avoid discomfort. Nasal rinsing should be done daily and preferably twice a day.
Saline solutions can be easily prepared at home by mixing clean, previously boiled, lukewarm water with unionized salt (9 grams of salt with 1 litre of water, or 3 grams in a nasal rinsing device) and pouring into a nasal rinsing device. These devices are available over-the-counter. Always prepare a fresh saline solution before use.
An additional effective option is nasal corticosteroid sprays or drops. These sprays:
They work by calming down inflammation in your nasal passages and sinuses. Corticosteroid sprays are safe to use in the long term. Some people can experience side effects like irritation, nose bleeding or dryness. However, a correct spraying technique can prevent most of the discomfort. Some of these sprays are available over the counter, but in some countries, you might need a prescription to get them.
Your doctor might also advise you to dissolve this drug into your saline solution for nasal rinsing. This is sometimes referred to as corticosteroid irrigation. Keep the spray by your toothbrush so as not to forget.
If you suffer from allergies, your physician may also prescribe anti-allergic pills or sprays (also called antihistamines). These medications can typically be bought over the counter at your pharmacy.
Sometimes your doctor might recommend a treatment for short term use. These therapies are not recommended for a long period or for frequent use due to adverse effects.
What is sinus surgery?
If symptoms don’t improve with nasal rinsing or corticosteroid sprays, there are additional options. One of the options your ENT specialist can consider is surgery.
The goals of sinus surgery are to:
Surgery is typically recommended only after trying the combination of nasal rinsing and nasal corticosteroids.
What to expect from sinus surgery?:
Sinus surgery is a complex procedure, and complications can happen during surgery. Talk to your doctor to discuss the pros and cons that are relevant to you. If symptoms worsen again, your doctor may need to review your treatment plan and consider more medical or surgical options.
In cases where symptoms persist after surgery and impact your daily life greatly, biologics can be considered. Biologics are only added to your current treatment after your doctor has made a detailed evaluation of your condition and the type of inflammation you suffer from. This process of figuring out the specifics of your condition is something your specialist may refer to as “endotyping” or “phenotyping”. This is important because biologics are special medications given by injection that target specific parts of your immune system that cause this inflammation.
While effective, this treatment can be expensive and does not always replace other medications completely. So it is often considered when other options have not worked.
Different biologics target various molecules (substances that act as messengers in your body) that play a role in inflammation. Your doctor will decide together with you which would be the best option for you to modulate your immune system and reduce symptoms.
Sometimes a biologic given for asthma also reduces CRS symptoms and vice versa.
How do biologics help?
The effects of biologics can vary from person to person because they are designed to treat specific types of inflammation.
Biologics are expensive and are not available everywhere, and access or reimbursement depends on local regulations. Talk to your doctor if you have specific questions about biologics therapy.
How to self-administer a biologic?
When starting treatment with biologics, your healthcare provider will train you how to give yourself a dose via injection. After practising a few times at the hospital, you will usually be able to do the injections by yourself at home (like insulin injections for diabetes). Since a proper technique is essential for the medicine to work and to ensure you get the full dose, we have created videos to assist you with the correct technique whenever you need it. There are two types of injections: (i) via prefilled pen or (ii) via prefilled syringe. Instructions depend on the device you use.
To help manage CRS, it is very important to take your medicines just as your doctor prescribes. This means following the dose and using them day in day out. As a tip, you might find it helpful to rinse your nose and use your nasal corticosteroid spray at the same time each day, like when you brush your teeth.
When you stick to your treatment plan, you are more likely to feel better and may avoid needing stronger short-term medicines with potential severe side-effects. Even if you have had surgery, keeping up with your treatment is also important because chronic inflammation needs long-term treatment. Without proper care, nasal polyps (small growths in the nose) can return. Using your medicines as directed can help lower this risk.
Taking your medicines the right way is just as important as taking them regularly. For the treatment to work properly, it needs to reach the affected area in your body. Take your time to watch the videos in this module and review any materials your doctor has provided about using your medicines correctly.
Some treatments, like corticosteroid sprays, need to be used regularly and may take 1 to 2 weeks to reach optimal effect. It is important to:
Using corticosteroid sprays over a long time is safe, but if your symptoms do not improve, get worse, or if new symptoms appear, schedule another appointment with your doctor.
If your symptoms remain hard to control even after trying first-line treatments, you may need to see a GP and/or ear, nose, and throat (ENT) specialist.
If you also notice lower airway symptoms, like shortness of breath or high-pitch lung sounds (called wheezing), it might be a sign of asthma. In that case, consider seeing a GP and/or a lung specialist (pulmonologist).
Recovery after sinus surgery can take up to several weeks to months. During this time:
If you are on biologics, regular check-ups with your ENT specialist are needed to monitor your progress. If your symptoms get worse during this treatment, it is essential to see your specialist right away.
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