Rhinology and Allergy: Rhinosinusitis

Publication Date: November 20, 2020

Key Points

Key Points

  • The various categories of rhinosinusitis — acute, chronic, in adults, in children, endotype, with and without polyps — are all common diagnoses with population prevalences running as high as 27% for chronic rhinosinusitis (CRS) in some countries in Europe and Canada but averaging mid-single digit percentages around the world.
  • There is considerable difference between acute rhinosinusitis, an infectious flare-up often treated with antibiotics, and chronic rhinosinusitis, primarily an inflammatory condition treated primarily with anti-inflammatory drugs.
  • CRS can have profound effects on functional well-being and general health-related quality of life (QoL). Validated patient reported outcomes measures reveal a day-to-day sense of well-being that is worse than congestive heart failure, chronic obstructive pulmonary disease and Parkinson’s disease.
    • Extra-sinus manifestations often drive these QoL scores.
      • Severe fatigue, bodily pain and poor sleep quality are frequent complaints that correlate with sinus-specific scores.
      • Cognitive function also suffers and improves with relief of sinus symptoms.
      • Depression tracks with sinus symptoms in roughly a third of patients.
  • The past 5 years have witnessed foundational progress in our understanding and treatment of rhinologic disease, including an emphasis on diagnostic algorithms, quality metrics, cost-effectiveness, and novel therapeutics.
    • The novel application of biologic therapies for chronic rhinosinusitis with and without nasal polyps (CRSwNP) has emerged as perhaps the most informative.
  • Aided by advances in molecular and statistical techniques, several research groups have worked toward defining endotypes, or biological inflammatory subtypes of CRS, based on mucus and tissue biomarkers. These are proving to have clinically meaningful implications.
  • The entire rhinologic community must quickly advance to a universally agreed upon, well-defined classification based upon endotypes.

Diagnosis

...gnosis

...ble 1. Diagnostic Criteria for ARSHaving trouble...


...e 2. Diagnostic Criteria for CRSHaving tro...


...1. Diagnostic Algorithm for ARS...


Figure 2. Diagnostic Algorithm f...


Treatment

...reatmen...

...e A/B Evidence-based Recommendations for Medical...


...le 4. Grade A/B Evidence-based Recommendati...


...nagement of Rhinosinusitis...


...Evidence for Surgical Timing and IndicationsHavin...


...6. Grade A/B Evidence-based Recommendations...


...ble 7. Anatomic Relationships to Consider During...


...ble 8. Evidence for Postoperative Care...


...ypical Risks, Side Effects, and Adverse Eff...