Chronic Rhinosinusitis Disease Program

Primary Care Referrals

A Major Referral Center

The Massachusetts General Hospital Chronic Rhinosinusitis Disease Program serves as a referral center for primary care providers and ear, nose and throat (ENT) specialists. We help patients with suspected or confirmed cases of severe chronic rhinosinusitis by:

• Evaluating their allergies
• Identifying the role of allergy, bacterial infection or immune deficiency
• Exploring novel therapeutic approaches

Our allergy/immunology specialists share all treatment recommendations with the referring physician and return the patient to his or her care whenever possible. Severe chronic rhinosinusitis generally requires lifelong medical management, which we are happy to coordinate with your referring physician.

What to Expect

At your first appointment, one of our allergy/immunology specialists will complete a comprehensive evaluation that includes:

• A review of your medical history, prior sinus CT scans and prior pathology reports (if you have had sinus surgery)
• A physical examination
• An evaluation of possible allergic, infectious and immunologic causes of your condition
• An assessment of your immune function if you have a history of recurrent infections

Based on the results of your evaluation, your allergy/immunology specialist likely will prescribe medication to manage your condition. In addition to antibiotics (a common approach for managing severe chronic rhinosinusitis), we offer innovative and effective therapies, such as topical antibiotic and antifungal sinus rinses and topical steroid rinses. In addition, patients with severe or recurrent nasal polyps are evaluated for possible treatment with injectable medications that have recently been approved for nasal polyps. We also offer aspirin desensitization for patients with “aspirin-exacerbated respiratory disease” or “AERD.”

Our specialists will also work with your local ENT physician or our ENT colleagues at Mass Eye and Ear to provide nasal endoscopy services or sinus surgery, when indicated, as these procedures are not performed at Mass General Allergy and Clinical Immunology Unit. Once we have stabilized your condition, we will review your progress with you periodically.

Our Team Approach Is a Major Advantage

Patients with severe chronic rhinosinusitis benefit from our program's team approach to care. World-class clinicians from related specialties at Mass General, including pulmonology and infectious disease, are available to assist in diagnosis and treatment. We also partner with ENT specialists from Massachusetts Eye and Ear to evaluate patients with unusual infections or other complicated cases.

Although medications prove effective in most cases, about 25 percent of our patients require surgery to alleviate their symptoms. When indicated, we will collaborate with Mass Eye and Ear specialists in making decisions about surgery and managing ongoing care, while the ENT surgeons at the Mass Eye and Ear typically perform the operation.

About This Program

The Mass General Chronic Rhinosinusitis Disease Program offers a full range of services at our downtown Boston campus and at our Waltham location.

Severe chronic rhinosinusitis is an inflammatory condition of the sinuses in which symptoms last 12 weeks or longer. Patients with severe chronic rhinosinusitis may also suffer from conditions such as:

• Nasal polyps
• Nasal allergies
• Allergic fungal rhinosinusitis
• Eosinophilic mucin rhinosinusitis
• Aspirin-exacerbated respiratory disease
• Vasculitis
• Other rare sinus conditions, such as immotile cilia syndrome

Our preference is to manage the patient's condition(s) with medications when possible. However, medications are not always effective in treating severe chronic rhinosinusitis caused by persistent infection, extensive nasal polyposis, poorly controlled asthma or certain other factors.

In these cases, we may refer patients to the world-class ENT surgeons at the nearby Massachusetts Eye and Ear for consideration of surgery. Following surgery, we may co-manage your ongoing care with the ENT specialist at Mass Eye and Ear.

Specialized Experience Makes a Difference

Our allergy/immunology specialists have extensive experience in caring for patients with severe chronic rhinosinusitis. Pinpointing the cause of this condition (e.g. bacterial infection, fungus or noninfectious inflammation) can be difficult. Our team's experience is a critical factor in making the correct diagnosis and developing an effective treatment plan.

Allergists/immunologists in our unit are known nationally and internationally for their clinical and research leadership in severe chronic rhinosinusitis. In order to advance the understanding and treatment of this condition, they have lectured and led workshops at many major gatherings of allergists and immunologists.

Groundbreaking Clinical Trials

As an elite academic medical center, Mass General is committed to conducting groundbreaking research that leads to improved care for patients with chronic sinus disease. We have conducted many clinical studies of novel therapies — e.g. nasal antifungal rinses, intranasal antibiotics, topical steroids and new injectable biologic agents — that have proven effective in treating severe chronic rhinosinusitis and nasal polyps.