Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses associated with severe impairments in patient quality of life, sleep, and productivity. Topical corticosteroid therapy is a key component to a successful management plan for patients with CRS. Delivering topical medical therapies using high-volume sinonasal irrigations are commonly used following endoscopic sinus surgery (ESS) due to its proven efficacy for improving drug delivery into the paranasal sinuses. Topical high volume budesonide irrigations have become a popular offlabel management strategy for CRS with the purpose to improve topical steroid delivery into the sinonasal cavities. Early evidence outlined in this review suggests that high volume sinonasal budesonide irrigations are an effective treatment modality in patients with CRS following ESS. Overall it appears that short-term use of this therapy is likely safe, however, future studies will need to assess the safety of higher doses and longer-term therapy of budesonide irrigations in patients with CRS.