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Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis. Laryngoscope 2019 01;129(1):37-44

Date

10/05/2018

Pubmed ID

30284272

DOI

10.1002/lary.27438

Abstract

OBJECTIVES/HYPOTHESIS: Endoscopic sinus surgery (ESS) is frequently performed for recurrent acute rhinosinusitis (RARS). Appropriate indications for surgery among patients with RARS have not yet been rigorously determined. The objective of this study was to define appropriateness criteria for ESS in the management of adult RARS.

STUDY DESIGN: Application of RAND-UCLA appropriateness methodology.

METHODS: A panel of nine multidisciplinary experts in RARS was formed to evaluate RARS scenarios generated from current evidence. The panel completed two rounds of a modified Delphi-ranking process and a teleconference.

RESULTS: A total of 32 clinical scenarios were ranked in each round. For adult patients with RARS, ESS can appropriately be offered as a treatment option when patients experience ≥ four annual episodes, and there is confirmation of at least one episode via computed tomography or nasal endoscopy, and the patient and clinician jointly participate in shared decision making, and the patient has either failed a trial of topical nasal steroids or experienced RARS-related productivity loss.

CONCLUSIONS: This study has defined appropriateness criteria for ESS as a management option for adult patients with RARS. These criteria are intended to represent a minimum threshold for which ESS should be considered in the treatment of RARS and do not suggest that all patients who meet these criteria should undergo surgery. These criteria may serve as a baseline set of indications for ESS in patients with RARS.

LEVEL OF EVIDENCE: NA Laryngoscope, 129:37-44, 2019.

Author List

Rudmik L, Beswick DM, Alt JA, Bhattacharyya N, Chester AC, Gray ST, Poetker DM, Stewart MG, Smith TL

Author

David M. Poetker MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Endoscopy
Female
Humans
Male
Paranasal Sinuses
Patient Selection
Recurrence
Rhinitis
Sinusitis
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280