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Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines.

Abstract

Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed.

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  • Authors+Show Affiliations

    ,

    Allergy and Asthma Medical Group and Research Center, 9610 Granite Ridge Dr, Ste B, San Diego, CA 92123, USA. eomeltzer@aol.com

    Source

    Mayo Clinic proceedings 86:5 2011 May pg 427-43

    MeSH

    Acute Disease
    Administration, Intranasal
    Administration, Oral
    Adrenal Cortex Hormones
    Anti-Bacterial Agents
    Chronic Disease
    Clinical Trials as Topic
    Evidence-Based Medicine
    Histamine Antagonists
    Humans
    Practice Guidelines as Topic
    Practice Patterns, Physicians'
    Quality of Life
    Rhinitis
    Sinusitis
    Sodium Chloride
    United States

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    21490181

    Citation

    Meltzer, Eli O., and Daniel L. Hamilos. "Rhinosinusitis Diagnosis and Management for the Clinician: a Synopsis of Recent Consensus Guidelines." Mayo Clinic Proceedings, vol. 86, no. 5, 2011, pp. 427-43.
    Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc. 2011;86(5):427-43.
    Meltzer, E. O., & Hamilos, D. L. (2011). Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clinic Proceedings, 86(5), pp. 427-43. doi:10.4065/mcp.2010.0392.
    Meltzer EO, Hamilos DL. Rhinosinusitis Diagnosis and Management for the Clinician: a Synopsis of Recent Consensus Guidelines. Mayo Clin Proc. 2011;86(5):427-43. PubMed PMID: 21490181.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. AU - Meltzer,Eli O, AU - Hamilos,Daniel L, Y1 - 2011/04/13/ PY - 2011/4/15/entrez PY - 2011/4/15/pubmed PY - 2011/7/27/medline SP - 427 EP - 43 JF - Mayo Clinic proceedings JO - Mayo Clin. Proc. VL - 86 IS - 5 N2 - Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/21490181/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)60033-5 DB - PRIME DP - Unbound Medicine ER -