Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis

Rudmik, Luke; Beswick, Daniel M.; Alt, Jeremiah A.; Bhattacharyya, Neil; Chester, Alexander C.; Gray, Stacey T.; Poetker, David M.; Stewart, Michael G.; Smith, Timothy L.

doi:10.1002/lary.27438

Cited by 11 publications

(24 citation statements)

References 43 publications

(109 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ESS leads to improved outcomes for patients with RARS in selected patient cohorts 22–25 . Current appropriateness criteria, intended to help guide surgical candidacy for RARS, have also included the need to confirm at least one true episode of ABRS prior to recommending ESS as a treatment option 21 . Findings from this current study highlight the importance of verifying an ABRS episode, as many patients with symptom‐based AEs did not have substantial intranasal inflammation consistent with an ABRS episode.…”

Section: Discussionmentioning

confidence: 79%

“…Clinical practice guidelines define the diagnosis of ABRS and RARS without requiring confirmation of objective inflammation, 2 which suggests that some degree of uncertainty is acceptable for diagnostic purposes and, by extension, consideration of certain treatments such antibiotic therapy. However, when surgical intervention for RARS is considered, multidisciplinary appropriateness criteria are more demanding and necessitate the confirmation of objective (endoscopic or radiologic) sinonasal inflammation to consider ESS 21 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Beswick¹,

Ayoub

Mace

et al. 2019

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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

Beswick¹,

Ayoub

Mace

et al. 2019

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

show abstract

“…The evidence for treatment of RARS is limited so the above-mentioned recommendations are mainly based on expert opinions and the interpretation of the available literature [314]. Discussing the risks, the potential complications of long-term repeated antibiotic therapy such as the development of resistance and gastrointestinal side-effects should be included.…”

Section: Patient Selection and Patient-centred Decisionmakingmentioning

confidence: 99%

Qualität in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen

Hildenbrand

Ketterer

2020

Laryngo-Rhino-Otol

View full text Add to dashboard Cite

Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 ZusaMMenfassung Die endonasale endoskopische Nasennebenhöhlenchirurgie hat sich als Standard der operativen Therapie bei chronisch entzündlichen Erkrankungen der Nasennebenhöhlen etabliert. Eine Verbesserung der subjektiven Beschwerden und objektiven Befunde konnte in zahlreichen Studien nachgewiesen werden. Aufgrund der häufig beobachteten Diskrepanz zwischen objektiven und subjektiven Ergebnissen nach Nasennebenhöhlenchirurgie kommt der Messung des sog. patient reported outcome eine zunehmende Bedeutung zu. Qualität und Effizienz in der Medizin haben in den letzten Jahren zunehmend an Bedeutung gewonnen. In vielen Ländern und auch länderübergreifend wurden bereits durch Zusammenschluss von Experten, z.T unter Federführung verschiedener Fachgesellschaften, Initiativen zur Verbesserung der Qualität in der chirurgischen Versorgung gegründet.Die vorliegende Arbeit stellt eine Übersicht qualitätsrelevanter Faktoren in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen anhand der vorhandenen Literatur, v.a. der Prozess-und Ergebnisqualität, dar. Ein besonderes Augenmerk liegt auf der subjektiven Bewertung der Ergebnisqualität durch den Patienten.absTraCT Endonasal endoscopic surgery of the paranasal sinuses is the gold standard in surgical treatment of chronic inflammatory diseases of the paranasal sinuses. Improvement of subjective complaints and objective findings has been confirmed in numerous studies. Due to the discrepancy between objective and subjective results after paranasal sinus surgery, the assessment of patient reported outcomes has gained importance.Quality and efficiency in medicine became increasingly important during the last years. In many countries and transnationally, the association of experts, partly coordinated by different medical societies, led to initiatives focusing on improvement of the quality of surgical care. The present article represents an overview of quality-related factors in surgical treatment of chronic inflammatory diseases of the paranasal sinuses, summarizing the existing literature and focusing particularly on process and outcomes quality. Particular attention will be paid to the outcome quality individually assessed by the patients. S5Online publiziert: 16.03.2020 Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 Referat < 200 200 -400 Anzahl der Operationen Anzahl der Kliniken in % > 400 57,6 % 38,3 % 36,4 % 12,8 % städtisch/kirchlich/privat Uniklinik Krankenhaus S7 Hildenbrand T et al. Qualität in der chirurgischen … Laryngo-Rhino-Otol 2020; 99: S5-S33 Referat ren < 20 Operationen pro Jahr durch. Zwischen 20 und 50 Operationen werden von 38,4 % der Kliniken durchgeführt und mehr als 50 Operationen geben lediglich 2 % der Kliniken an (▶abb. 2). 83,1 % aller Kliniken gaben an, an einem interdisziplinären Tumorboard teilzunehmen und 68,4 % führen interdisziplinäre Tumoroperationen bei Erkrankungen der Nasennebenhöhle...

show abstract

“…The RAND/UCLA appropriateness methodology is well-described and has previously been utilised defining appropriateness criteria for ESS during the management of uncomplicated adult CRS and adult recurrent acute rhinosinusitis. 9,11,13 No such criteria or high-quality evidence for the management of our cohort of patients has been described in the literature to date.…”

Section: Appropriateness Criteria For Ess Prior To Dental Implant Smentioning

confidence: 99%

Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography

Amin

Walker

Alobid

et al. 2020

Clinical Otolaryngology

View full text Add to dashboard Cite

Objectives: Conebeam computed tomography (CBCT) imaging is commonly requested by dental implant surgeons, preoperatively, for patients being considered for dental implants. Incidental maxillary sinus findings often result in otolaryngology (ENT) referral for further assessment. CBCT findings include transient and benign mucosal changes that may not require any intervention and therefore unnecessarily delay implant surgery. We aim to define appropriateness criteria for ESS in the management of adult dental implant patients with incidental maxillary sinus findings on CBCT and provide guidance to both dental implant and ENT surgeons. Design: The RAND/UCLA appropriateness methodology was used to develop and define the appropriateness criteria. Setting: A virtual panel of 13 international experts in ESS. Participants: The expert panel completed two rounds of a modified Delphi ranking process for nine clinical scenarios, considering various factors affecting decisionmaking processes. Main outcome measures: To define appropriateness criteria for ESS in adult dental implant patients who have incidental maxillary sinus findings on CBCT. Results: Patients with clinical symptoms and endoscopic findings of chronic rhinosinusitis together with an obstructed ostiomeatal complex (OMC) and concentric mucosal thickening of the ipsilateral maxillary sinus or pansinusitis were deemed appropriate candidates for ESS prior to their dental implant. ESS was not appropriate in asymptomatic patients with a patent OMC and mucosal thickening isolated to floor of the ipsilateral maxillary sinus. For uncertain scenarios, further discussion between dental implant and ENT surgeon should be considered. How to cite this article: Amin N, Walker A, Alobid I, et al. Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography.

show abstract

Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis

Cited by 11 publications

References 43 publications

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

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

Qualität in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen

Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography

Contact Info

Product

Resources

About