3
Key Action Statements
Table 2. Summary of Guideline Key Action Statements (KAS)
Statement Action Grade
KAS 1A and 1B:
Verification of
Diagnosis and
Assessment of
Candidacy for
Surgery
1A. e surgeon should verify an
existing diagnosis of chronic
rhinosinusitis to ensure established
diagnostic criteria (signs and
symptoms) from clinical practice
guidelines are met AND
Strong
recommendation
AND
1B. e surgeon should assess
candidacy for sinus surgery
based on symptoms, disease
characteristics, quality of life, and
prior medical or surgical therapy.
Strong
recommendation
KAS 2. No one-size-fits-
all regimen
e surgeon should not endorse or
require a predefined, one-size-fits-
all regimen or duration of medical
therapy (e.g., antibiotics, steroids,
antihistamines) as a prerequisite to
sinus surgery for an adult with chronic
rhinosinusitis.
Recommendation
KAS 3. Assessment
before prescribing
antibacterial
therapy
e surgeon or their designee should
not prescribe antibacterial therapy to
an adult with chronic rhinosinusitis if
significant or persistent purulent nasal
discharge (anterior, posterior, or both)
is absent on examination.
Strong
recommendation
KAS 4. Relative benefits
of surgery or
medical therapy
alone
e surgeon should identify patients
with chronic rhinosinusitis that would
benefit most from surgery and are least
likely to benefit from continued medical
therapy alone, such as those with chronic
rhinosinusitis subtypes that include, but
are not limited to, chronic rhinosinusitis
with polyps, polyps with bony erosion,
eosinophilic mucin, or fungal balls.
Recommendation
KAS 5. Patient education
about surgery
and long-term
management
e surgeon or their designee should
counsel patients before sinus surgery to
establish realistic expectations, including
the potential for chronicity or relapse,
and the likelihood of long-term medical
management, taking into account their
chronic rhinosinusitis subtype.
Recommendation
KAS 6. When to offer
sinus surgery
e surgeon should offer sinus surgery
to an adult with chronic rhinosinusitis
when the anticipated benefits exceed
that of nonsurgical management alone,
there is clarity regarding the anticipated
outcomes, and the patient understands
the expectation for long-term disease
management following surgery.
Recommendation
