xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

0.46% in revision surgery. 98,105 While altered anatomy and adhesions can increase the risks of complications during revision ESS, the actual revision ESS complication rate has not been shown to be significantly different than primary ESS rates. 98,106 I.C.5.e. Postoperative Care Following ESS In studies of postoperative management, 1 problem con tinues to be the heterogeneity of reported postoperative health metrics which is likely related to the need for clini cians to optimize for both short-term and long-term patient outcomes. While some evidence may assess a particular outcome, it might not address the entire clinical spectrum. The following represents the best current evidence for a range of postoperative interventions following ESS. I.C.6 CRS and COVID-19 The coronavirus disease 2019 (COVID-19) pandemic, caused by the virus SARS-CoV-2, has heightened aware ness and necessitated modifications to the workup and management of sinonasal pathologies including CRS. Notably, olfactory dysfunction, a cardinal symptom of CRS, has been highlighted as a prevalent symptom of COVID 19. 3,107–110 Olfactory dysfunction is acute and profound, and may be the sole manifestation of disease. Unlike anos mia found in CRS, COVID-19-associated olfactory loss presents with no radiographic evidence of olfactory cleft disease or mucosal thickening of the sinuses. 111,112 Impor tantly, olfactory loss has high diagnostic value as the strongest symptomatic predictor of COVID-19 with poten tial for early disease screening. 107,113,114 The prevalence of olfactory dysfunction has varied widely between 15% and 96% based on self-reported and quantitatively measured data. 115–117 The COVID-19 pandemic has necessitated flexibility in our treatment algorithms for CRS as guided by patient preference and concerns for viral transmission. Topical intranasal corticosteroids (INCS) are recommended and maintained even during SARS-CoV-2 infection. 118,119 There is no evidence that INCS are associated with increased infectivity. Some fear discontinuing INCS may not only worsen symptoms but increase viral shedding due to coughing and sneezing. The utility and appropriateness of oral steroids remain more controversial as their effects on COVID-19 lung injury are debated, 120 though more recent studies have shown improvement in COVID-19 mortality rate. 121 Given the high viral burden found on nasal mucosal surfaces, 2 the otolaryngologic field has carefully assessed the risks of airborne aerosol production during both diag nostic and therapeutic endonasal procedures. However,

minimum of 3-4 week trial of AMT prior to surgical intervention

Recommendation for AMT prior to surgical intervention. Option: Antibiotics

Recommendation for AMT prior to surgical intervention.

Recommendation for

Option: Oral Corticosteroids

Benefit-Harm Assessment Policy Level

Differ by therapy and clinical scenario

Differ by therapy and clinical scenario

Differ by therapy and clinical scenario

medications and treatment of

adverse events

medications and treatment of

adverse events

medications and treatment of

adverse events

Direct Cost of

TABLE I-5 Evidence for surgical timing and indications Intervention Grade Benefit Harm Cost AMT: CRSsNP INCS, Saline Irrigations, Antibiotics D Symptomatic improvement, avoidance of risks and costs of surgical intervention Risk of medication adverse events, potential for increasing antibiotic resistance; See Table II-1. Direct Cost of AMT: CRSwNP INCS, Saline Direct Cost of

Risk of medication adverse events,

potential for increasing antibiotic resistance; See Table II-1.

Risk of medication adverse events,

potential for increasing antibiotic resistance; See Table II-1.

D Symptomatic Improvement, Avoidance of risks and costs of surgical intervention

avoidance of risks and costs of surgical intervention

D Symptomatic improvement,

AMT: Duration of 3-4 weeks

Irrigations, Oral

Corticosteroids (Single short course)