xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

evidence of at least 1 acute episode by endoscopy or CT, failed trial or INCS, or presence of significant productivity losses. Barham 205 2017 4 Case Series Suspected RARS RARS diagnosis CT findings rarely abnormal during acute exacerbations of symptoms. RARS rare diagnosis. Rudmik 209 2017 4 RAND modified Delphi methodology N/A Quality indicator prioritized ranking

Given possible alternate diagnoses and lack of CT evidence of sinonasal inflammation, antibiotics and surgery inappropriate in this population. Within top 2 disease category priorities for rhinology-specific quality improvement Loftus 207 2016 4 Case Series RARS patients CT anatomic variation

In light of absent objective evidence of sinonasal inflammation, RARS AE may be over-diagnosed. RARS patients can benefit from both medical and surgical treatment options.

Surgical treatment may have greater symptomatic improvement vs medical treatment. Endoscopic and CT scores are low in RARS

patients and do not necessarily correlate with response to medical therapy or need for surgery.

Infraorbital ethmoid cell, concha bullosa, accessory ostia, reduced infundibular width associated withRARS.

Anatomic variants are not a risk factor for RARS. No correlation between presence of specific anatomic variants and severity of inflammatory changes on CT.

TABLE V-5 Evidence for the definition of recurrent acute rhinosinusitis Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Beswick 204 2019 3 Retrospective outcomes research RARS patients SNOT-22 scores Endoscopy scores Acute episodes (AE) associated with worse QoL scores. Patients with AE had worse endoscopy scores than patients not in AE. Not all patients with subjective AE had endoscopic evidence of sinonasal inflammation. Costa 208 2015 3 Cohort study/cross-over study RARS-medical therapy RARS-surgical RARS-cross over SNOT-22 scores CT anatomic variation

Appropriateness criteria for surgery include 4 or more annual episodes of ABRS, objective

Appropriateness methodology RARS clinical scenarios Appropriateness for ESS

Rudmik 206 2019 4 RAND-UCLA