In this study, patients who have had previous endoscopic sinus surgery and present with an
acute exacerbation of chronic rhinosinusitis will be offered endoscopic-guided,
culture-directed antibiotic therapy. They will then be randomized to receive oral or
intranasal topical antibiotics. Both of these are considered standard of care, but there is
some limited data suggesting superiority of topical antibiotics especially if guided by
culture and in patients who have undergone previous surgery. However, a study that directly
compares the two has not been published. Modified Lund-Kennedy endoscopic finding scores and
subjective SNOT-22 questionnaires will be collected before and at 3-4 weeks after treatment.
Medication-related sided effects will be noted and analyzed. After 6-8 month follow-up, we
will analyze the rate of recurrence of exacerbations, need for further antibiotics, need for
revision surgery, and SNOT-22 scores based on oral versus topical antibiotic treatment. Our
objective is to evaluate both short and long-term response to both oral and topical
administration of antibiotics in this patient population in order to determine if either
route of administration is superior to the other.