title: Recalcitrant chronic rhinosinusitis: investigation and management.
abstract: OBJECTIVE
  We discuss the care of patients failing the typical medical and surgical management for chronic rhinosinusitis who need further evaluation to rule out various mimics of sinus disease and other disorders that may require specific treatment plans. We also look at the many treatment options for the recalcitrant sinusitis patient recently published.
  
  
  RESULTS
  Work-up of diseases such as gastroesophageal reflux, dental infection and immunodeficiency in the chronic rhinosinusitis patient are discussed. There have been multiple treatment options evaluated in the literature in the past year, including long-term macrolide therapy and various antibiotic, antifungal, and surfactant irrigations. Recommendations regarding these therapies are discussed.
  
  
  CONCLUSIONS
  Patients with recalcitrant chronic rhinosinusitis offer a significant challenge to the otolaryngologist. This review provides a structured look at both diagnosing and treating the disease processes in these patients, with recently published literature presented.
authors.affiliation: Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15219, USA. woodburykw@upmc.edu
authors.forename: Kristin
authors.initials: K
authors.lastname: Woodbury
authors.forename: Berrylin J
authors.initials: BJ
authors.lastname: Ferguson
mesh_terms: D002908:Chronic Disease; D006801:Humans; D012220:Rhinitis / Q000209:etiology* / Q000628:therapy; D012852:Sinusitis / Q000209:etiology* / Q000628:therapy