Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study

Abstract

This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment "option" during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment "option" and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high-quality, patient-centered care to patients with CRS.

Automated classification of osteomeatal complex inflammation on computed tomography using convolutional neural networks

“…As such, CT imaging represents an integral part of the workup and management of chronic sinusitis. Most patients electing to proceed with sinus surgery receive a preoperative CT scan 1 , and a recent ESS appropriateness study defined the presence of inflammation on CT as a minimum criterion for surgical intervention 2 . Due to the high rate of recurrent disease and need for revision 3 , some patients may also receive multiple CT scans of the sinuses over their lifetime.…”

The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice

“…Using these tools in daily practice may also allow for more direct applicability of the results from clinical studies. For example, preoperative instrument scores have also been used to determine which patients are best suited for surgery . More specifically, data suggest SNOT‐22 scores of at least 20 in those who have failed maximal medical therapy indicate sufficient symptom impact to warrant endoscopic sinus surgery; accordingly, an international expert panel endorsed this threshold value as one of three operative indications on which their group could achieve consensus .…”

“…For example, preoperative instrument scores have also been used to determine which patients are best suited for surgery . More specifically, data suggest SNOT‐22 scores of at least 20 in those who have failed maximal medical therapy indicate sufficient symptom impact to warrant endoscopic sinus surgery; accordingly, an international expert panel endorsed this threshold value as one of three operative indications on which their group could achieve consensus . In patients with sensorineural hearing loss, randomized clinical trial data suggest that those with Inner EAR scores of 27 (95% CI: 25‐28) improve, on average, to a score of 65 when amplification devices are utilized .…”

THE 2017 13TH ANNUAL DAVID W. KENNEDY, MD, LECTURE The evolution of outcomes in sinus surgery for chronic rhinosinusitis: past, present, and future

“…I am trying to convey the fact that the data suggest that the information currently supplied to us in the form of sinus CT appears to be over emphasized by clinicians. 33 We should keep this possibility in mind.…”