xRead - Nasal Obstruction (September 2024) Full Articles

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445

Orlandi et al.

(Continues)

methodology to recommendations for management of RS CRS is defined as presence of 2 + symptoms for > 12 weeks, 1 of which must be nasal identify and grade

discharge or nasal obstruction in addition to presence of facial pain/pressure or hyposmia.

Anterior rhinoscopy/endoscopy should be done to identify polyps.

Presence of polyps and dyssomnia can distinguish between normal and diseased patients.

Failure of nasal steroids after 5 week trial suggest possible CRS and should prompt imaging confirmation.

For patients meeting symptom criteria for CRS, a nasal endoscopy can improve diagnostic accuracy (improves the

specificity, PPV, and NPV to 84.1, 66, 70.3 from 12.3, 39.9, 62.5, respectively).

Addition of nasal endoscopy was not shown to statistically improve diagnosis of CRS in patients who failed to meet guidelines.

Strong recommendation for the diagnostic criteria based on multiple clinical consensus statements.

Diagnosis of CRS entails at least 2 CPODS present for 8-12 weeks plus documented objective finding (CT or endoscopy) of inflammation of the paranasal sinuses/nasal mucosa.

Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Cottrell 522 2018 2 Literature review Adult CRS pts

Evaluate correlation between CRS symptoms and

radiographic findings

diagnostic accuracy of

CRS with use of nasal endoscopy

Develop CRS-specific quality indicators to

evaluate diagnosis and management

Thomas 530 2008 2 Clinical Practice Guidelines CRSwNP Evidence-based

Improvement in

Exclusion criteria: Pts < 18yoa,

referred with CRS

202 adult patients who presented

for evaluation of CRS.

systemic diseases

resulting in CRS, non-English guidelines

703 patients

double-blind diagnostic study

(3 guidelines, 1 consensus

statement)

Bhattacharyya 480 2010 3 Prospective diagnostic cohort

Bhattacharyya 1328 2006 3 Prospective

TABLE X-1 (Continued)