Chronic rhinosinusitis Figure 2 CT scan of sinuses with sinusitis (Tichenor 2006). Note: +, thickening of the maxillary sinus; *, middle meatus; CT, computed tomography; E, ethmoid sinuses; M, maxillary sinus; O, maxillary sinus ostium; P, polyp. contribute to the problem of antibiotic-resistant bacteria. There has been some use of inhaled topical antibiotics for CRS; a few uncontrolled studies have reported efficacy with these treatments, but controlled trials are needed to demonstrate effectiveness of this therapy (Slavin et al 2005). Antihistamines are not recommended for CRS, unless the patient has an accompanying allergic rhinitis. Also, although topical and oral decongestants are often used, side effects such as rhinitis medicamentosa (with topical agents) and hypertension (with oral agents) can occur (Slavin et al 2005). Intranasal corticosteroids have been shown to relieve symptoms in CRS, but it is unclear if this is due to simply a decrease in nasal congestion or to decreased inflammation in the sinuses themselves. There is evidence that corticosteroids (topical and oral) are effective against nasal polyps (Slavin et al 2005). Studies have also shown that Therapeutics and Clinical Risk Management 2007:3(2) irrigation with hypertonic saline alleviates symptoms in CRS patients (Heatley et al 2001; Slavin et al 2005). When there is documented underlying disease in CRS, treatment of the underlying condition may help relieve CRS symptoms as well. For example, intravenous immunoglobulin (IVIG) therapy should be given to patients with immunodeficiency, to prevent serious complications due to CRS (subperiosteal and intracranial abscesses, meningitis, sepsis, and death). Aspirin desensitization is recommended in patients with aspirin-exacerbated airway disease (Slavin et al 2005). Surgery has long been a treatment of choice for persistent CRS, and with the advent of endoscopy, most surgeries are now minimally invasive. The main point of endoscopic sinus surgery (ESS) is to clear blockage and ensure patency of the osteomeatal complex (OMC) — the common drainage 323