What lifestyle modifications or adjunct therapies can be recommended to patients with chronic rhinosinusitis to improve their symptoms?

Lifestyle modifications and adjunct therapies recommended for patients with chronic rhinosinusitis to improve symptoms include:

• Avoidance of triggers such as smoking and allergic triggers, and management of associated conditions like asthma and allergic rhinitis, as these predispose to chronic sinusitis and controlling them benefits sinusitis symptoms.
• Stopping smoking and avoiding passive smoking.
• Practising good dental hygiene to reduce the risk of dental infections that can be associated with bacterial sinusitis.
• Avoidance of underwater diving due to risk of sinus barotrauma.
• Use of nasal saline irrigation with isotonic saline or Ringer’s lactate to relieve nasal congestion and discharge; this is safe and effective in both adults and children.
• Use of intranasal corticosteroids (e.g., mometasone or fluticasone) for up to 3 months, especially if allergic causes are suspected; these are effective and safe in adults and supported for children based on safety and anti-inflammatory effects.
• Consideration of a short course of systemic corticosteroids (1–2 courses per year) in adults with partially controlled or uncontrolled disease as an adjunct to nasal corticosteroids, with specialist advice recommended before use.
• Temporary use of nasal decongestants may be considered when the nose is very blocked, but generally not recommended for chronic use.
• Good control of comorbidities such as asthma and allergic rhinitis is important to improve sinusitis symptoms.

Referral to specialists is advised if symptoms persist beyond 6–12 weeks, if there are complications, or if there is suspicion of anatomical defects or immunological causes.

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