Chronic Rhinosinusitis · Medical vs FESS

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Duration/objective evidence + medical response + complications
   CRS confirmed? Response to medical therapy? Any complications?
   • CRS (≥12 weeks + endoscopy/CT evidence), not adequately treated medically → CRS → guideline medical therapy
   • Guideline maximal medical therapy failed → Medical failure → FESS
   • Complications (orbital/intracranial, mucocele, acute invasive fungal, tumor) → Complications → emergency/urgent surgery
2. [End] CRS → guideline medical therapy
   CRS → medical therapy first: nasal corticosteroids, saline irrigation, control allergy; for polyps/eosinophilic type add a short oral steroid course ± biologic; for bacterial add culture-directed antibiotics.
3. [End] Medical failure → FESS
   Guideline maximal medical therapy (including nasal steroids + a ~3-month course) failed → functional endoscopic sinus surgery (FESS) to open the sinus ostia, preserving mucosa; continue nasal steroid irrigation maintenance postoperatively.
4. [End] Complications → emergency/urgent surgery
   Complications (orbital cellulitis/abscess, intracranial, mucocele compression, acute invasive fungal, suspected tumor) → emergency/urgent surgery + targeted treatment (antifungals/biopsy).

Source guidelines & references

• Chronic rhinosinusitis management (EPOS 2020; AAO-HNS adult sinusitis guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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