Conservative Phytotherapeutic Management of Chronic Rhinosinusitis Post-FESS in Type II Diabetes Mellitus Patients

Abstract

Chronic rhinosinusitis (CRS) in patients with type 2 diabetes mellitus (T2DM) poses a therapeutic challenge, especially in the postoperative period after functional endoscopic sinus surgery (FESS). Conventional therapy (corticosteroids, antibiotics, saline) often has limited efficacy and carries risks (e.g. steroid-induced hyperglycemia and antibiotic resistance). In this context, phytotherapy – the use of herbal medicinal agents – offers multimodal benefits (anti-inflammatory, antimicrobial, mucosal healing) with good tolerability. For example, Chinese herbal formulas (e.g. Biyuan Tongqiao granules) have been shown in meta-analyses to significantly improve symptoms and quality-of-life scores (SNOT-20, VAS) in CRS. Likewise, agents such as bromelain (a pineapple enzyme) and propolis (bee resin) have demonstrated enhanced mucosal healing and symptom relief in small trials. Here we review and propose a structured herbal regimen as an adjunctive conservative treatment after FESS in T2DM patients, summarizing evidence from clinical studies and discussing potential mechanisms. This approach aims to reduce inflammation, control infection, and promote mucosal regeneration without exacerbating glycemic control.