Virtually all patients who are candidates for simultaneous rhinoplasty and FESS seek the advice and treatment of a physician because of their sinus complaints. As with any presenting problem, the clinician should elicit a through medical history with a particular focus on the sinus complaints as well as any functional and nasal deformities. Aspects that should be addressed include the duration of symptoms, associated allergic symptoms, overuse of topical decongestants, prior nasal surgery, failure to respond to medical therapies in the past, and trauma. In addition, if headaches and facial pressure are described, their exact location and possible association with certain allergic factor and visual disturbances should be ascertained. Migraines or neuralgias should be considered in the differential diagnosis.
Chronic rhinosinusitis represents a multifactorial inflammatory disorder, rather than simply a persistent bacterial infection.  The medical management of chronic rhinosinusitis is now focused upon controlling the inflammation that predisposes patients to obstruction, reducing the incidence of infections. However, all forms of chronic rhinosinusitis are associated with impaired sinus drainage and secondary bacterial infections. Most individuals require initial antibiotics to clear any infection and intermittently afterwards to treat acute exacerbations of chronic rhinosinusitis.