Patients with refractory chronic rhinosinusitis, by definition, have persistent, poorly controlled symptoms and objective inflammatory findings despite prior medical and surgical therapy. These patients represent a diagnostic and treatment challenge given the complexity of the underlying disease factors and the limitations in available management options. This article presents a practical framework for clinical evaluation and treatment. Germane to discussion are emerging concepts in refractory chronic rhino sinusitis that will likely have important implications in the near future.
