2
Key Points
➤ This clinical practice guideline (CPG) focuses on the surgical
management of chronic rhinosinusitis (CRS) for adults.
➤ It addresses primary surgery and adjuvant therapies in detail, with
discussion of revision surgery when related to specific topics.
➤ The objectives are to optimally guide the preoperative, intraoperative,
and postoperative care for patients undergoing sinus surgery, including
how to educate, communicate, and make decisions with patients.
➤ The overarching goal is to provide a trustworthy, evidence-based
reference for those making decisions about whether to utilize
endoscopic sinus surgery (ESS) and the extent to which it should be
performed.
Table 1. Definitions Related to Chronic Rhinosinusitis
Term Definition
Chronic
Rhinosinusitis
(CRS)
Twelve weeks or longer of two or more of the following
symptoms or signs:
ick and/or discolored drainage (anterior, posterior, or both),
nasal obstruction (congestion), facial pain, pressure, fullness, or
decreased sense of smell AND inflammation as documented by
one or more of the following findings:
Abnormal mucus or edema in the middle meatus or anterior
ethmoid region, polyps in the nasal cavity or middle meatus,
and/or radiologic imaging showing inflammation of the
paranasal sinuses.
Complicated
rhinosinusitis
Extraparanasal sinus extension:
Extension of disease beyond the confines of the sinuses, for
example, orbital or intracranial spread.
Acute rhinosinusitis
(ARS)
Up to 4 wk of discolored nasal drainage (anterior, posterior, or
both) accompanied by nasal obstruction, facial pain, pressure,
or fullness. Nasal obstruction may be reported by the patient as
nasal obstruction, congestion, blockage, or stuffiness, or may be
diagnosed by physical examination.
Facial pain, pressure, or fullness may involve the anterior face,
periorbital region, or manifest with headache that is localized or
diffuse.
Recurrent acute
rhinosinusitis
Four or more episodes per year of acute bacterial rhinosinusitis
(ABRS) without signs or symptoms of rhinosinusitis between
episodes.
Surgical
management
Preoperative, intraoperative, and postoperative decisions and
surgical interventions.
Primary surgery e initial operative intervention for CRS.
Revision surgery Surgery for CRS, which occurs subsequent to the initial operative
intervention, for example, for recurrence of disease.
