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Diagnosis and management of chronic rhinosinusitis in adults.
Postgrad Med. 2009 Nov; 121(6):121-39.PM

Abstract

Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.

Authors+Show Affiliations

UT-Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX 75390-7208, USA. bradley.marple@utsouthwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19940423

Citation

Marple, Bradley F., et al. "Diagnosis and Management of Chronic Rhinosinusitis in Adults." Postgraduate Medicine, vol. 121, no. 6, 2009, pp. 121-39.
Marple BF, Stankiewicz JA, Baroody FM, et al. Diagnosis and management of chronic rhinosinusitis in adults. Postgrad Med. 2009;121(6):121-39.
Marple, B. F., Stankiewicz, J. A., Baroody, F. M., Chow, J. M., Conley, D. B., Corey, J. P., Ferguson, B. J., Kern, R. C., Lusk, R. P., Naclerio, R. M., Orlandi, R. R., & Parker, M. J. (2009). Diagnosis and management of chronic rhinosinusitis in adults. Postgraduate Medicine, 121(6), 121-39. https://doi.org/10.3810/pgm.2009.11.2081
Marple BF, et al. Diagnosis and Management of Chronic Rhinosinusitis in Adults. Postgrad Med. 2009;121(6):121-39. PubMed PMID: 19940423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and management of chronic rhinosinusitis in adults. AU - Marple,Bradley F, AU - Stankiewicz,James A, AU - Baroody,Fuad M, AU - Chow,James M, AU - Conley,David B, AU - Corey,Jacqueline P, AU - Ferguson,Berrylin J, AU - Kern,Robert C, AU - Lusk,Rodney P, AU - Naclerio,Robert M, AU - Orlandi,Richard R, AU - Parker,Michael J, AU - ,, PY - 2009/11/27/entrez PY - 2009/11/27/pubmed PY - 2010/1/9/medline SP - 121 EP - 39 JF - Postgraduate medicine JO - Postgrad Med VL - 121 IS - 6 N2 - Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/19940423/Diagnosis_and_management_of_chronic_rhinosinusitis_in_adults_ L2 - http://www.tandfonline.com/doi/full/10.3810/pgm.2009.11.2081 DB - PRIME DP - Unbound Medicine ER -