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International consensus statement on rhinosinusitis

SPECT single proton emission CT SPG sphenopalatine ganglion

tables, and literature summary tables, Table II-1 defines known and typical side effects and adverse effects for com monly utilized treatment modalities that should be con sidered when determining policy level recommendations. Table II-1 may not include all possible risks of listed inter ventions. Introduction “The body of knowledge regarding rhinosinusitis (RS) con tinues to expand.” With that statement, we introduced the 2016 International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS-2016). 1 Five years later, this statement rings truer than ever. We noted that in the 15 years preceding ICAR-RS-2016, 12,847 articles had been published on the subject of RS. In the 5 years since, an additional 6952 have been published and the annual num ber continues to grow (Figure III-1). This ICAR-RS-2021 evaluates and summarizes this evidence into a consumable format for the busy clinician to stay up to date on the latest advances in the field of RS. The expanded knowledge contained in those nearly 7000 publications mandates an update of the ICAR RS-2016 document. This 2021 ICAR-RS document incor porates this additional evidence and, where necessary, adjusts recommendations based on the updated evidence. Every one of the more than 140 ICAR-RS-2016 sections have been updated and more than 40 additional sections have been added in order to keep up with new areas of investigation as well. While the evidence has grown dramatically, the basic methodology for this ICAR document has remained largely unchanged. The ICAR-RS-2016 statement adapted the “evidence-based review with recommendations” framework set down by Rudmik and Smith in 2011, which uses a blinded online iterative review process. 4 Internationally recognized experts contributed to the document as both section authors and blinded reviewers of others’ sections, culminating in an overall consensus statement that all authors agreed upon. During the cre ation of ICAR-RS-2016, we found this method robustly emphasized the published, peer-reviewed evidence and minimized bias and the influence of expert opinion. Five years later we remain convinced of its effectiveness. More over, since the publication of ICAR-RS-2016, this same methodology has been successfully applied to the subjects of allergic rhinitis and skull base surgery, with others in development. 135,136 In comparing this ICAR-RS-2021 update to the 2016 doc ument, the reader will see there have been significant advances in our understanding of pathophysiology and III

SPINK5 serine protease inhibitor Kazal-type 5 SPLUNC1 Short palate, lung and nasal epithelium clone 1 SPT skin prick testing T2R taste receptor family 2 T2R38 taste receptor 2 member 38 protein TAS2R38 taste receptor 2 member 38 gene TC CFTR triple combination cystic fibrosis trans membrane conductance regulator therapy (elexacaftor-tezacaftor-ivacaftor) TFF trefoil factor family TGF transforming growth factor Th Thelper TID three times daily TIVA total intravenous anesthesia TIW three times weekly TLR toll-like receptor TMEM16A transmembrane member 16A TNF tumor necrosis factor TNSS total nasal symptom score TSLP thymic stromal lymphopoietin TSST toxic shock syndrome toxin UB unblinbded UES upper esophageal sphincter UPSIT University of Pennsylvania Smell Identifi cation Test URI upper respiratory infection US FDA United States Food and Drug Administra tion VAS visual analog scale VCAM vascular cell adhesion molecule VD3 Vitamin D VDR vitamin D receptor VEGF vascular endothelial growth factor VGDFFiM vapors, gases, dusts, fumes, fibers, andmists XLA X-linked agammaglobulinemia ZO-1 zona occludin-1 TP-1 thymostimulin TPS total polyp score TRE target registration error II.B Possible Adverse Effects of Common Rhinosinusitis Treatments Throughout ICAR-RS-2021, possible side effects or treat ment risks of interventions are considered. In order to stan dardize listing of these possible side effects and treatment risks within the text, Aggregate Grade of Evidence (AGE)