Anatomic variants of the paranasal sinuses in patients with recurrent acute rhinosinusitis

Loftus, Patricia A.; Lin, Juan; Tabaee, Abtin

doi:10.1002/alr.21658

Cited by 19 publications

(30 citation statements)

References 19 publications

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“…Surgical appropriateness criteria for RARS suggest a diagnosis should include at least 4 episodes per year as well as objective evidence (endoscopic or radiologic) of an acute exacerbation 206 . There are also conflicting reports on whether sinonasal anatomic variations are associated with or predispose patients to RARS 207,208 . Despite the growing literature, RARS is still an under‐examined entity and has been identified as one of the top priorities for rhinology‐specific quality improvement in the future 209 …”

Section: Definitionsmentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

518

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Definitionsmentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

518

479

View full text Add to dashboard Cite

show abstract

“…Predisposing factors for ARS are seldom evaluated. There is some indication that anatomical abnormalities may predispose to recurrent acute rhinosinusitis (RARS) (44)(45)(46)(47) . Active and passive smoking predisposes to ARS and there is some evidence that concomitant chronic disease may increase the chance of getting ARS following an influenza infection (48)(49)(50) .…”

Section: Predisposing Factors For Ars and Rarsmentioning

confidence: 99%

Executive Summary of EPOS 2020 Including Integrated Care Pathways

Fokkens

Lund

Hopkins

et al. 2020

Rhin

358

254

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The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012 (1-3). The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence

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“…RARS has been associated with significant direct and indirect costs (e.g., >$1,000 healthcare costs and >4 missed workdays per patient per year), with upward of 100,000 patients affected by this disease in the United States 4 . Limited research into the pathogenesis of RARS has been conducted, though many clinicians would agree that alterations and compromise of ostiomeatal complex anatomy or physiology are involved 5–8 . Originating from both a paucity of current evidence and related to diagnostic uncertainty, RARS has been identified as a top‐two area of research by the American Rhinologic Society 9 …”

Section: Introductionmentioning

confidence: 99%

Acute Exacerbations in Recurrent Acute Rhinosinusitis: Differences in Quality of Life and Endoscopy

Beswick¹,

Ayoub

Mace

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: Research surrounding outcome differences for patients with recurrent acute rhinosinusitis (RARS) is scarce. This investigation explored quality of life (QOL) and sinonasal attributes in patients during acute episodes (AEs) and in-between AEs of RARS. Study Design: Retrospective outcomes research. Methods: Data from patients with RARS were collected from two academic institutions between 2009 and 2017 using prospective and retrospective methodology. During clinical presentation, subjects were classified as with or without an AEs using guideline definitions of acute bacterial rhinosinusitis (ABRS). Between-group differences in 22-item Sino-Nasal Outcome Test (SNOT-22) survey and Lund-Kennedy (LK) endoscopy scores were assessed. Results: Four hundred twenty-three clinical visits from 202 patients were included. Visits during an AE (168/423, 40%) were associated with significantly worse SNOT-22 total scores compared to between AEs (255/423, 60%; median = 53.0 [interquartile range (IQR) = 24.0] vs. 34.0 [IQR = 29.5]) and all SNOT-22 subdomain scores (all P < .001). LK scores were available for 167 visits, with 56 (34%) completed during an AE. Compared to visits without an AE, endoscopy findings associated with an AE were less frequently normal (LK score = 0, 45% vs. 62%, P = .031) with worse median LK scores (2.0 [IQR = 4.0] vs. 0.0 [IQR = 2.0], P = .005). Conclusions: AEs are associated with significantly worse QOL and mildly worse endoscopic findings. Almost half of visits during AEs had negative endoscopy, identifying a disparity between patient symptoms and objective findings and calling into question alternative or concomitant diagnoses. Diagnostic criteria for ABRS or AEs in RARS do not require objective confirmation of inflammation, presenting a conundrum for clinicians. The potential for overdiagnosis of ABRS and AEs should be considered when determining the risk/benefit ratio of treatments for RARS.

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Anatomic variants of the paranasal sinuses in patients with recurrent acute rhinosinusitis

Abstract: This study describes the incidence of anatomic variants in a cohort of patients with RARS. A correlation between the presence of anatomic variants and the pattern of inflammatory changes was not identified.

Cited by 19 publications

References 19 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Executive Summary of EPOS 2020 Including Integrated Care Pathways

Acute Exacerbations in Recurrent Acute Rhinosinusitis: Differences in Quality of Life and Endoscopy

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