Long-term, low dose macrolide therapy represents one attempt at controlling the inflammation associated with chronic sinusitis (80). Medicines that have anti-inflammatory properties and are well tolerated are sought to help ease the reliance on systemic corticosteroids that affect both the number and function of inflammatory cells. When used in a topical form, nasal steroid sprays have been shown to be safe and effective in reducing the symptoms of alleric rhinitis (81). Their use in patients with chronic sinusitis can decrease the size of nasal polyps, and diminish sinomucosal edema (82). There are no set guidelines for the duration of use, and the expected side effects from long-term use are not yet known. Experience in using oral steroids for the treatment of chronic sinusitis is only anectodal. The extended use of oral steroid may result in serious side effects that include muscle wasting and osteoporosis. Because of the side effects, steroids are tapered and given in short courses that may span only three to four weeks.
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