Specialist management may involve further medical care (such as initiation of antibiotics) or endoscopic sinus surgery when there are complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment [ 20 ] . It is aimed at restoring sinus ventilation to correcting mucosal opposition in order to restore the mucociliary clearance system. This is limited by long-term scarring and adhesions around the ostium of the sinus. To address this, balloon catheter dilation of the sinus ostia (balloon cineplasty) has been developed [ 23 ] . This new technique appears promising both in terms of technical success rate and symptomatic relief. To date, it has been associated with a low complication rate [ 23 ] .
Decongestant nasal sprays are available over-the-counter in many countries. They work to very quickly open up nasal passages by constricting blood vessels in the lining of the nose. Prolonged use of these types of sprays can damage the delicate mucous membranes in the nose. This causes increased inflammation, an effect known as rhinitis medicamentosa or the rebound effect . Decongestant nasal sprays are advised for short-term use only, preferably 5 to 7 days at maximum. Some doctors advise to use them 3 days at maximum. A recent clinical trial has shown that a corticosteroid nasal spray may be useful in reversing this condition.  Topical nasal decongestants include: