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560

International consensus statement on rhinosinusitis

TABLE XII-5 Evidence for appropriate medical therapy prior to surgery

Systemic corticosteroids

Guideline

Antibiotics

INCS

Saline Irrigation Other

Not specified

Oral or topical

AAOA Guidelines 2009 526

Yes

Yes

Yes for CRSwNP or CRSsNP if initial 2 week treatment fails

decongestants

AAO-HNS

Yes – culture directed

Optional

Optional

Optional

Treatment of AR

Guidelines 2015 88

BSACI 2008 1921

Yes

Leukotrienes optional in AERD patients; Antihistamines for AR Leukotrienes optional in AERD patients

macrolide

Yes

Yes in mod/severe CRSwNP; No for CRSsNP Yes in CRSwNP; Optional in CRSsNP

antibiotics

Canadian

Yes – culture directed

Yes

Optional

Guidelines 2011 151

EPOS2020 26

Yes

Optional

Yes

Optional long term macrolides for CRSsNP

TABLE XII-6 Results of surveys to establish medical therapy trial prescribing habits prior to surgery

Systemic corticosteroids

Survey

Antibiotics

INCS

Saline Irrigation Other

AAOHNS Survey 2006, n = 80 1197 ARS Survey, 2007 n = 308 1922 Chinese Oto-HNS Alliance Survey, 2020 n = 134 1923 ENTUK Survey, 2013, n = 159 1924

94%

94%

34%

47% oral decongestants 47% mucolytics

51% always, 30% almost always 19% always, 34% often

10% always, 20% almost always

51% always, 40% often

3% always, 12% often 35% always, 45% often

92%

61% always, 27% sometimes

4% always, 30% sometimes

23% always, 42% sometimes

3% antihistamines 4%topical decongestants

TABLE XII-7 Duration of medical therapy trials prior to surgery recommended by major guidelines

Systemic corticosteroids

Guideline

Antibiotics

INCS

Saline Irrigation

3-4weeks

At least 1 month

8-12days

Not specified

AAOA Guidelines 2009 526

AAO-HNS

2-4weeks

Not specified

Not specified

Not specified

Guidelines 2015 88

"Slightly longer

Not specified

2 weeks in CRSwNP; Optional in CRSsNP

Not specified

Canadian

than for ABRS"

Guidelines 2011 151

EPOS2020 26 BSACI 2007 1921

Not explicitly stated

6-12weeks

1-3weeks 5-10days

6-12weeks

Not specified

Yes

12weeks of

macrolide antibiotics