Guideline sources The following summarized guidelines for the evaluation and management of chronic rhinosinusitis are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2015). 1 2 2 2 3 Definition Chronic rhinosinusitis is defined as the evidence of inflammation in the sinonasal mucosa for greater than 12 weeks characterized by sinus pressure, nasal congestion, rhinorrhea, and decreased sense of smell. 2 Epidemiology A complex interplay of host factors (defects in mechanical, innate, and adaptive components of immune system) and environmental factors (allergens, toxins, microbial agents) have been implicated in the development of chronic rhinosinusitis. 3 Disease course Clinical manifestations of persistent sinus pressure, nasal congestion, rhinorrhea, and a decreased sense of smell. 2 Prognosis and risk of recurrence Chronic rhinosinusitis is not associated with increased mortality. 2 https://web.pathway.md/diseases/rectsg5AKaA4hYz1i 1/3 6/23/23, 3:26 AM Chronic rhinosinusitis Pathway Guidelines 1. Screening and diagnosis Diagnostic criteria: confirm a clinical diagnosis of chronic rhinosinusitis with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or CT. B 2. Diagnostic investigations Initial evaluation: Confirm the presence or absence of nasal polyps patients with chronic rhinosinusitis. B Assess patients for comorbid conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. B Allergy and immune function testing: consider allergy and immune function in evaluating a patient with chronic rhinosinusitis or recurrent acute rhinosinusitis. C 3. Medical management Symptomatic treatment: offer saline nasal irrigation, topical intranasal corticosteroids, or both for relief of symptoms in patients with chronic rhinosinusitis. B Antifungal therapy: avoid topical or systemic antifungal therapy for patients with chronic rhinosinusitis. D References 1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152 2 Suppl):S1 S39. Open 2. Whitney W. Stevens, Robert J. Lee, Robert P. Schleimer et al. Chronic Rhinosinusitis Pathogenesis. J Allergy Clin Immunol. 2015 Dec; 136 6 1442 1453. Open 3. Kent Lam, Robert Schleimer, Robert C Kern. The Etiology and Pathogenesis of Chronic Rhinosinusitis: a Review of Current Hypotheses. Curr Allergy Asthma Rep. 2015 Jul;15 7 41.2015 Jul;15 7 41. Open 4. American Academy of Ophthalmology. Choosing Wisely AAO recommendations. Choosing Wisely. 2015. Open 5. Kent Lam, Robert Schleimer, and Robert C. Kern. The Etiology and Pathogenesis of Chronic Rhinosinusitis: a Review of Current Hypotheses. Curr Allergy Asthma Rep. 2015 Jul; 15 7 41. Open 6. Whitney W Stevens, Robert J Lee, Robert P Schleimer et al. Chronic rhinosinusitis pathogenesis. J Allergy Clin Immunol. 2015 Dec;136 6 1442 1453.2015 Dec;136 6 1442 1453. Open https://web.pathway.md/diseases/rectsg5AKaA4hYz1i 2/3 6/23/23, 3:26 AM Chronic rhinosinusitis Pathway 7. I Mel n. Chronic sinusitis: clinical and pathophysiological aspects. Acta Otolaryngol Suppl. 1994;515 45 8. Open 8. M Duse, S Caminiti, A M Zicari. Rhinosinusitis: prevention strategies. Pediatr Allergy Immunol. 2007 Nov;18 Suppl 18 71 4. Open 9. Jay F Piccirillo, Spencer C Payne, Richard M Rosenfeld et al. Clinical Consensus Statement: Balloon Dilation of the Sinuses. Otolaryngol Head Neck Surg. 2018 Feb;158 2 203 214. Open 10. Ioana Agache, Yang Song, Pablo Alonso-Coello et al. Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines. Allergy. 2021 Aug;76 8 2337 2353. Open https://web.pathway.md/diseases/rectsg5AKaA4hYz1i 3/3