We thank Dr Ahmadizadeh for his letter and for the opportunity to reply. We agree that whenever possible, underlying conditions that predispose to chronic rhinosinusitis should be addressed first. Such attempts may include treating concurrent allergic conditions, smoking cessation, or other environmental controls. We advocate these methods for all patients suffering from chronic rhinosinusitis, not only for those with chronic recurrent rhinosinusitis after endoscopic sinus surgery. It is not clear to us that ciliary disorders and immunoglobulin deficiencies can be readily treated as an underlying cause in many cases. In patients in whom such conservative measures fail, we have found antibiotic therapy efficacious in treating acute exacerbations of rhinosinusitis in the postoperative setting. Discordance between culture results and true in vivo pathogens is always a possibility, but we suggest that treatment should be based on the best information at hand, which we believe is the culture result. Dr Ahmadizadeh points out, rightly, that failure after endoscopic sinus surgery, especially with respect to patient expectations, may result when surgery is prematurely performed. However, in our series, all patients who underwent surgery met the clinical criteria defined by the American Academy of Otolaryngology–Head and Neck Surgery Task Force on Rhinosinusitis, and failed medical management.1 Chronic rhinosinusitis remains a multifactorial disorder, and we agree that its pathogenesis remains unsettled.
Bhattacharyya N, Kepnes LJ. Antimicrobial Treatment and Recurrent Rhinosinusitis—Reply. Arch Otolaryngol Head Neck Surg. 2000;126(5):690. doi: