Clinical Review

Management of chronic rhinosinusitis

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7054 (Published 30 October 2012) Cite this as: BMJ 2012;345:e7054
  1. Kim Lawrence Ah-See, senior medical student1,
  2. Jane MacKenzie2,
  3. general practitioner,
  4. Kim Wong Ah-See, consultant otolaryngologist head and neck surgeon3
  1. 1University of Edinburgh Medical School, Edinburgh EH16 4TJ, UK
  2. 2Skene Medical Practice, Aberdeen, UK
  3. 3Otolaryngology Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
  1. Correspondence to: kim.ah-see{at}nhs.net

Summary points

  • Chronic rhinosinusitis (CRS) is a chronic inflammatory condition of the nasal passages and paranasal sinuses

  • CRS can occur with or without nasal polyps

  • The mainstay of treatment is topical corticosteroids

  • Facial pain is a poor diagnostic indicator of CRS

  • Where medical therapy does not resolve symptoms, patients require referral to an ear, nose, and throat specialist

Chronic rhinosinusitis (CRS) is a common medical condition presenting to the primary care physician. The 2012 update of the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) reported that it may affect between 5% and 15% of the population in Europe and the United States, although high quality epidemiological data is scarce.1A multicentre questionnaire survey of adults in Europe estimated that one in ten participants had CRS but with notable geographic variation.2 Prevalence estimates for nasal polyps are difficult to achieve given the need for nasal endoscopy for a reliable diagnosis—questionnaire data may overestimate the prevalence of nasal polyps.3

One American study analysing a multiemployer database from 1991 ranked sinusitis as the ninth most costly health condition.4

Sources and selection criteria

We searched Medline, the Cochrane Library, and PubMed using the search terms “chronic rhinosinusitis”, “rhinosinusitis”, “rhinitis”, “sinusitis”, “chronic disease”, and “nasal polyps”. We also referenced expert position papers such as the European Position Paper on Rhinosinusitis and Nasal Polyps.1 When possible, we used level I evidence from systematic reviews or randomised controlled trials.

What is chronic rhinosinusitis?

Rhinosinusitis is the appropriate term used to describe the common concurrence of inflammation and infection within the nasal passages and paranasal sinuses.5 The EP3OS taskforce (a group of international experts who appraise and report on the available literature) developed a clinical definition of rhinosinusitis that is based on the Allergic Rhinitis and its Impact on Asthma (ARIA) group guidelines (box 1).1 …

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