Acute exacerbations of chronic rhinosinusitis: The current state of knowledge

Abstract

Objectives: Acute exacerbations of chronic rhinosinusitis (AECRS) are distinct from baseline symptomatology related to chronic rhinosinusitis (CRS). In this review, we seek to examine the literature on AECRS to synthesize the definition, epidemiology, pathophysiology, treatment, and impact of AECRS on CRS patients.Methods: A comprehensive narrative review of the scientific literature, identified by searching PubMed from inception through April 2022, was performed.Results: AECRS is defined in consensus guidelines as a worsening of chronic sinus disease symptomatology, with a return to baseline, typically after intervention with systemic antibiotics and/or corticosteroids. The working definition used across the literature, however, is broad and heterogeneous. The pathophysiology of AECRS is incompletely understood but is hypothesized to include an interplay of environmental and patient-specific factors. AECRS have been found to have a negative impact on quality-of-life measures, independent of baseline CRS symptomatology, and impact how patients and physicians view overall disease control. Treatment for AECRS includes oral antibiotics and systemic corticosteroids, although their efficacy for AECRS is unclear. Appropriate use of medical and surgical treatment for CRS can reduce the frequency of AECRS.Conclusions: AECRS are a distinct entity in CRS patients and should be independently assessed when evaluating patients for CRS control. The efficacy of systemic medication usage for AECRS is currently unclear, but appropriate medical management of baseline CRS can reduce the frequency of AECRS. More research is needed to further understand this phenomenon, including a more precise and prospective definition, defined epidemiology, and how to appropriately treat.

Advanced pharmacy practice of a doctor of pharmacy student at an allied surgical ward in a hospital in Africa

“…Although antibiotics are frequently used for the treatment of acute exacerbation of chronic rhinosinusitis (AECRS), the data are inconclusive regarding their efficacy [ 20 ]. A single randomized control trial to date examined the use of antibiotics in AECRS.…”

“…These include over the counter medications such as decongestants, mucolytics, acupuncture and other complementary medicine therapy. Yet no studies exist on the use of these therapies in AECRS [ 20 ].…”

“…The goals of therapy were to improve the patient's quality of life, promote sinus drainage, reduce mucosal edema in the nasal cavity, eradicate infections that may be present in the nasal cavity and associated cavities, reduce the number of hospital visits and to prevent the development of orbital and intracranial complications [ 20 ].…”

Establishment of a duration criterion for acute exacerbations of chronic rhinosinusitis through qualitative analysis of patient experiences

“…AECRS are currently defined in consensus guidelines as a transient worsening of symptoms that return to baseline symptoms, often requiring intervention with systemic corticosteroids or antibiotics 3,4 . Because of the inexact nature of this definition of AECRS, many previous research studies have used patient‐reported use of systemic antibiotics and corticosteroids for CRS as proxy measures for AECRS 5,6 …”

“…3,4 Because of the inexact nature of this definition of AECRS, many previous research studies have used patient-reported use of systemic antibiotics and corticosteroids for CRS as proxy measures for AECRS. 5,6 In a recent study by our group, which directly investigated patient experiences with AECRS using interviews and qualitative methodology, we proposed an evidencebased and patient-centered definition for AECRS as: "A flare up of symptoms beyond day-to-day variation to which a distinct negative impact on a patient's QOL or functionality can be attributed." 7 However, there remains a need to establish a duration criterion for the increased symptoms that defines the occurrence of an AECRS.…”