xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

Recommendation against: CAg may have anti-bacterial properties in-vitro but lacks

efficacy in clinical studies

Recommendation: Aspirin desensitization should be

considered in AERD after

surgical removal of NPs to prevent recurrence.

Option postoperatively in CRSsNP and CRSwNP patients.

Option: Topical furosemide after ESS and in combination with an INCS may reduce the

recurrence of nasal polyps

Option: Montelukast is an option for CRSwNP patients either instead of or in addition to INCS

Benefit-Harm Assessment Policy Level

LowtoHigh No benefit in light of potential harm

Clear benefit over harm

Low Preponderance of mild benefit over harm

outweighs harm

when used on a

rotating basis as studied

Moderate Balance of benefits and harm

Low Benefits likely

Moderate

(Including

cost of desen sitization)

Lowto

Intervention Grade Benefit Harm Cost CRSwNP:

< 3% GI side effects with low-dose protocols

Potential increase in serum silver levels

GI bleeding, increased morbidity in renal

disease and clotting

dysfunction at high

maintenance doses.

discomfort, stinging

No studies have been performed to assess

systemic safety with nasal delivery

Montelukast associated with neuropsychiatric events. Zileuton

associated with elevated

liver enzymes requiring monitoring; See Table II-1.

Occasional local

Limited risks.

B(-) No benefit for the use of in clinical studies

A Reduced post-op polyp re-recurrence,

increased QoL and

reduced symptoms. Reduced need for systemic

corticosteroids and surgical revisions

improvement in the 2 small RCTs in postoperative patients

B Reduced recurrence of nasal polyps

following ESS over

placebo nasal spray

A Improvement in symptoms

comparable to INCS. May have limited

benefit as an adjunct to INCS

B Symptomatic

TABLE I-4 (Continued)

CRSs/wNP: Colloidal Silver CRSwNP:

CRSwNP (AERD): ASA

Desensitization

Anti-Leukotrienes

CRSs/wNP: Xylitol Irrigation

Furosemide