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Chronic Rhinosinusitis (CRS) constitutes a longstanding disease process and a significant health hazard. Its pathophysiology may entail inherent epithelial irregularities, infectious insults, antigenic fermentations, and anatomic abnormalities, acting separately or in cooperation. Hence, various state-of-the-art treatment modalities have evolved, focusing on the surgical restoration of sinus homeostasis: endoscopic approach and visualization, fine surgical tools, power-instrumentation, precise imaging, combination of intranasal and external accesses, and navigation techniques. Despite the impressive technological advances in operative interventions, the medical aspects of CRS have not been investigated to the same extent, and the relevant remedies have changed very little over the years. Topical therapy in CRS is a relatively novel methodology, which relies on the local pharmacological management of sinus inflammatory status, and aims to supplement the existing treatment options. Topically applied medications have been used successfully for decades in dermatology, ophthalmology and urology. This chapter reviews the philosophy of topical therapy for CRS, its applications and effectiveness, as well as our institution’s experience and findings regarding a complete local treatment protocol utilized for the management of refractory CRS.

Topical Membrane Therapy for Chronic Rhinosinusitis