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Just published May 27th, 2025, American Academy of Otolaryngology - Head and Neck Surgery, released their new guideline on the Surgical Management of Chronic Rhinosinusitis.

The objective of this guideline is to identify quality improvement opportunities and provide clinicians with trustworthy, evidence-based recommendations for the surgical management of chronic rhinosinusitis in adults.

There are 11 recommendations in these guidelines so let’s get started

  • The surgeon should verify an existing diagnosis of chronic rhinosinusitis to ensure established diagnostic criteria (signs and symptoms) from clinical practice guidelines are met  AND The surgeon should assess candidacy for sinus surgery based on symptoms, disease characteristics, quality of life, and prior medical or surgical therapy. 
  • The surgeon should not endorse or require a predefined, one-size-fits all regimen or duration of medical therapy (e.g., antibiotics, steroids, antihistamines) as a prerequisite to sinus surgery for an adult with chronic rhinosinusitis.
  • The surgeon or their designee should not prescribe antibacterial therapy to an adult with chronic rhinosinusitis if significant or persistent purulent nasal discharge (anterior, posterior, or both) is absent on examination. 
  • The surgeon should identify patients with chronic rhinosinusitis that would benefit most from surgery and are least likely to benefit from continued medical therapy alone, such as those with chronic rhinosinusitis subtypes that include, but are not limited to, chronic rhinosinusitis with polyps, polyps with bony erosion, eosinophilic mucin, or fungal balls.
  • The surgeon or their designee should counsel patients before sinus surgery to establish realistic expectations, including the potential for chronicity or relapse, and the likelihood of long-term medical management, taking into account their chronic rhinosinusitis subtype.
  • The surgeon should offer sinus surgery to an adult with chronic rhinosinusitis when the anticipated benefits exceed that of nonsurgical management alone, there is clarity regarding the anticipated outcomes, and the patient understands the expectation for long-term disease management following surgery.
  • For an adult who is a candidate for sinus surgery, the surgeon or their designee should obtain a computed tomography (CT) scan with a fine-cut protocol, if not already available, to examine the paranasal sinuses for surgical planning. 
  • The surgeon should not plan the extent of sinus surgery (e.g., which specific sinuses to operate on) solely based on arbitrary criteria regarding a minimal level of mucosal thickening, sinus opacification, or outflow obstruction on a CT scan. 
  • The surgeon or their designee should educate an adult with chronic rhinosinusitis who is scheduled for sinus surgery regarding anticipated postoperative care, specifically pain control, debridement, medical management, activity restrictions, return to work, duration and frequency of follow-up visits, and the potential for recurrent disease or revision surgery. 
  • When the sinus involves polyps, osteitis, bony erosion, or fungal disease in an adult with chronic rhinosinusitis who is scheduled for sinus surgery, the surgeon should perform sinus surgery that includes full exposure of the sinus cavity (lumen) and removal of diseased tissue, not just balloon or manual ostial dilation, or refer the patient to a surgeon who can perform this extent of surgery.
  • The surgeon or their designee should follow up to assess outcomes of sinus surgery for chronic rhinosinusitis, between 3 and 12 mo after the procedure, through history (symptom relief, quality of life, complications, adherence to therapy, need for rescue medications, and ongoing care) and nasal endoscopy.

Make sure to check out the full guideline and other clinical tools from the American Academy of Otolaryngology - Head and Neck Surgery at guidelinecentral.com

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