Rhinosinusitis; otorhinolaryngological perspective for its treatments

Abstract

  Caldwell-Luc surgery was established at the end of 19th century and then had been performed widely as main surgery for rhinosinusitis until very recently. Endonasal approaches were attempted separately, however, competent performance could not be obtained due to narrow operation field, bleeding and risk of surrounding vital organs. In 1990s, advancement in optical technology had endoscopic sinus surgery（ESS）established, and then the concept of sinus surgery has changed. At present, ESS is still developing and the indication of ESS has been extended into tumor and other diseases. As conservative treatments, low-dose, long-term administration of macrolides has been established as the first-line, standard treatment.

  These two main treatments, ESS and macrolides, have been established, but refractory types of rhinosinusitis have emerged. New treatments based on molecular pathophysiology of rhinosinusitis will be necessary in future.