Chronic rhinosinusitis

### What you need to know A 35 year old hairdresser presents to her general practitioner with a two year history of a blocked and runny nose. When she tried using an over-the-counter beclomethasone nasal spray, she did not notice any improvement. As she cannot breathe through her nose, she finds it hard to get to sleep and to exercise. Chronic rhinosinusitis is a common condition with a prevalence of 10.9%.1 It can have a major impact on quality of life, affecting sleep, exercise, and activity. Intranasal treatments are effective for most people2 but need to be used correctly and regularly. This article offers an evidence based approach to diagnosis and management. Aim to determine any precipitating factors or associated disease, and differentiate between structural and inflammatory nasal blockage (although both can be present). Try to establish the effect that symptoms are having on quality of life to help direct joint decision making and stepwise treatment. Acknowledging this impact can be useful in the consultation, as patients often feel embarrassed for seeking healthcare for a chronically blocked or runny nose, as they worry that such symptoms may be perceived as trivial.