title: Medical therapy, refractory chronic rhinosinusitis, and productivity costs.
abstract: OBJECTIVE
  The purpose of this review is to address the most recent advances in the medical therapy for chronic rhinosinusitis (CRS), define recalcitrant and refractory CRS, and discuss the productivity costs associated with CRS.
  
  
  RESULTS
  Recent studies evaluating anti-IL-4 receptor α antibodies and calcium channel blockers have demonstrated promising early results during management of CRS. Recent appropriateness criteria have been developed to assist clinicians with defining which patients have 'refractory' CRS and may be considered candidates for endoscopic sinus surgery. Productivity costs appear to be associated with disease severity and can be reduced with appropriate interventions.
  
  
  CONCLUSIONS
  Topical corticosteroid therapy and high volume saline irrigation continue to be the cornerstone to medical therapy, whereas use of systemic corticosteroids and antibiotics depends on CRS phenotype and presence of acute exacerbation. More research is needed before routine use of novel immunomodulatory therapies such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers. Clinicians should apply an appropriate definition for refractory CRS when discussing role of sinus surgery. Assessing the degree of work productivity impairment can assist in treatment decision-making and may help predict treatment outcomes.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Smith
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D004724:Endoscopy; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007167:Immunotherapy / Q000379:methods*; D015848:Interleukin-5 / Q000276:immunology; D010256:Paranasal Sinuses / Q000601:surgery*; D019948:Receptors, Interleukin-4 / Q000276:immunology; D012008:Recurrence; D012220:Rhinitis / Q000191:economics / Q000628:therapy*; D012852:Sinusitis / Q000191:economics / Q000628:therapy*
chemical_list: D000911:Antibodies, Monoclonal; D002121:Calcium Channel Blockers; D015848:Interleukin-5; D019948:Receptors, Interleukin-4; D007073:Immunoglobulin E