EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

Abstract

The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, 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. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…The presence of CRS is assessed on the basis of clinical symptoms such as nasal discharge, in combination with facial pain/pressure or loss of smell, present for a period of at least 12 weeks [64]. The SNOT-22 questionnaire may be used for assessing symptoms [64], and CT of the sinuses and rhinoscopy may be used to assess the presence of sinus inflammation and polyposis [64].…”

“…The SNOT-22 questionnaire may be used for assessing symptoms [64], and CT of the sinuses and rhinoscopy may be used to assess the presence of sinus inflammation and polyposis [64]. …”

“…Nasal steroids, systemic steroid treatment, antibiotics, functional endoscopic sinus surgery and aggressive nasal lavage are recommended for the treatment of CRS [64] and improve nasal symptoms. Whereas both medical and surgical interventions have been shown to improve nasal outcomes, there are not convincing data to suggest an improvement in asthma-related outcomes.…”

Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre

“…Chronic rhinosinusitis (CRS) is defined as inflammation of the nose and the paranasal sinuses characterized by two or more symptoms, one of which should be either nasal blockage or nasal discharge in addition to facial pain/pressure and/or reduction of smell, lasting for at least 12 weeks 1. The latter symptoms should be supported by endoscopic findings or computed tomography (CT) scan changes 1.…”

“…The latter symptoms should be supported by endoscopic findings or computed tomography (CT) scan changes 1. Within the 2012 European Position Paper on Sinusitis (EPOS) document, clinicians are provided with evidence‐based treatment algorithms for CRS.…”