Adjunctive Therapy

Adjunctive therapy is intended to promoted drainage of secretions and improve oxygenation to the obstructed sinus ostia. Multiple agents with different mechanisms of action are often administered. These include decongestants that are alpha-adrenergic agonists that constrict the capacitance vessels and decrease mucosal edema. Topical therapy such as oxymetazoline or neosynephrine may be used in an acute setting, but overuse can cause a rebound effect and rhinitis medicamentosa. Systemic decongestants can be used for longer periods of time, but may cause insomnia and exacerbation of underlying systemic hypertension.

Antihistamines are used in patients with underlying allergic rhinitis. They can relieve symptoms of itching, rhinorrhea, and sneezing in allergic patients, but in nonallergic patients they can cause thickening of secretions, which may prevent needed drainage of the sinus ostia.

Guaifenesin (glyceryl guaicolate) given in a daily dose of 2400 mg thins secretions, thus facilitating drainage. Nasal saline irrigations are helpful in thinning secretions and may provide a mild benefit in nasal congestion. Hypertonic saline irrigations improve patient comfort and quality of life, decrease medication use, and diminish the need for surgical therapy (83).

Leukotriene inhibitors are systemic medications that block the receptor and/or production of leukotrienes, potent lipid mediators that increase eosinophil recruitment, goblet cell production, mucosal edema, and airway remodeling. Their role in chronic sinusitis and nasal polyposis is not yet well established (84).

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