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Adult Sinusitis

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Table 3. Summary of Key Action Statements (KAS) (continued) Statement Action Strength 7a. Diagnosis of CRS or recurrent ARS Clinicians should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms. R-C 7b. Objective confirmation of a diagnosis of CRS Clinicians should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. S-B 8. Modifying factors Clinicians should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. R-B 9. Testing for allerg y and immune function Clinicians may obtain testing for allerg y and immune function in evaluating a patient with CRS or recurrent ARS. O-C 10. CRS with polyps Clinicians should confirm the presence or absence of nasal polyps in a patient with CRS R-A 11. Topical intranasal therapy for CRS Clinicians should recommend saline nasal irrigation, topical intranasal corticosteroids, or both, for symptom relief of CRS R-A 12. Antifungal therapy for CRS Clinicians should NOT prescribe topical or systemic antifungal therapy for patients with CRS. R-A against a Watchful waiting can be implemented using a WASP (wait-and-see antibiotic prescription) or SNAP (safety-net antibiotic prescription) and by informing the patient to fill the prescription and begin antibiotic therapy if they fail to improve within 7 days or if they worsen at any time. b For penicillin-allergic patients either doxycycline or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended.

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