The goal of this study is to highlight the most recent advancements in medical treatment for chronic rhinosinusitis (CRS), define stubborn and refractory CRS, and analyze the productivity costs associated with CRS. Recent trials exploring anti-IL-4 receptor antibodies and calcium channel blockers in the treatment of CRS have shown encouraging early findings. Recently new suitability criteria have been created to help physicians in determining whether individuals have ‘refractory’ CRS and may be candidates for endoscopic sinus surgery. Productivity costs appear to be related to illness severity and can be decreased with the right interventions.

The cornerstones of medical therapy are topical corticosteroid therapy and large volume saline irrigation, whereas the use of systemic corticosteroids and antibiotics is dependent on CRS phenotype and the occurrence of acute exacerbation. More study is needed before new immunomodulatory treatments such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers may be used on a regular basis. When considering the role of sinus surgery, clinicians should use an acceptable diagnosis for refractory CRS. Assessing the degree of work productivity impairment can help guide treatment decisions and predict treatment outcomes.