BSACI guidelines for the management of rhinosinusitis and nasal polyposis

Abstract

SummaryThis guidance for the management of patients with rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded. These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener's granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management.

Hyaluronan in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis

“…We have also performed secondary screening CT scans, rhinomanometry, and a saccharine clearance test. Furthermore, in agreement with the British Society for Allergy and Clinical Immunology, we performed a prick skin test on all patients because an association between CRS and allergy in more than 60 % of cases has been reported in the literature [1]. In our sample of 80 patients the incidence of allergy was 42 %.…”

“…Rhinosinusitis is characterized by mucosal inflammation of the nasal cavity and paranasal sinuses, and is associated with nasal congestion or obstruction, facial pain and olfactory disturbance [1]. Chronic Rhinosinusitis (CRS) is defined as rhinosinusitis that persists longer than 12 weeks.…”

“…The aetiology of CRS is multifactorial and comprises a cycle of pathophysiological, anatomical, and constitutive factors. Diagnosis of CRS is primarily based on symptoms that are confirmed by endoscopy and computed tomography [1].…”

“…Nasal polyps (NP) are associated with a more severe subset of CRS and result when the oedematous lining blocks the nasal cavity to a significant degree [1]. More than 80 % of polyps occur due to eosinophilic inflammation.…”

Upper airway. 3: Sinonasal involvement in chronic obstructive pulmonary disease

“…The presence of chronic nasal symptoms suggests that COPD may be associated with chronic rhinosinusitis. Difficulties in assessing sinonasal disease using symptoms alone has led national 13 and international 14 guideline committees additionally to require objective evidence of disease on physical examination or imaging studies. To date there are no reports of sinonasal imaging in COPD, but further evidence of sinonasal involvement has been provided by studies of nasal inflammation.…”