Evaluation of ESS effectiveness in improving quality of life. This includes an evidence-based regimen for appropriate medical therapy to pursue before considering surgery, said Dr. Orlandi, as well as intraoperative technique, and pre- and postoperative care.
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May 2016Looking Ahead
Dr. Orlandi hopes that the statement’s publication will spur more questions and higher-level research. “We hope to better understand the heterogeneity within CRS,” he said. “Previously, it was thought of as either one or two conditions, but there are far more than that. When we better define the different disease states, we can then understand the more than a dozen treatments we’ve examined.”
An enhanced understanding of how different treatments work on the various RS subtypes would also help better target individual medical therapy. “Where one treatment might not work well overall, it might have great effect in a subtype,” said Dr. Orlandi. “We’ve all seen that in our practices—there will be one patient who will respond to a particular treatment when most don’t. We need to better define what treatments work best for which subtypes. It’s analogous to targeting particular cancer cells with specific chemotherapy types.”
Dr. Tabaee believes that this statement will help clinician scientists have a common dialogue about the missing areas of information ripe for scientific research. “Interestingly, the statement raises as many questions as it answers,” he says. “There are areas of recently identified pathophysiology including biofilms and genetic predisposition that do not have a clear pathway in diagnosis or treatment in the clinical work place. Further, identifying which patients will likely benefit from surgery earlier rather than later in the disease course is still a work in progress. This research statement creates a common platform for translating the current literature to clinical care considerations that are supported by scientific evidence and equally importantly highlights fundamental aspects of CRS that require further investigation.”
Amy E. Hamaker is a freelance medical writer based in California.
Methodology
Because of the deeply entrenched knowledge and practice for RS, steps were taken to safeguard against “expert opinion bias” using systematic reviews and semi-anonymous contributions and critiques. Methodology followed a five-step process:
- Each of 144 RS topics was assigned to one of 76 rhinology experts worldwide.
- Briefly, a systematic review was performed with grading of all evidence. An initial author drafted a summary of the evidence with an aggregate evidence grade and, where applicable, a structured recommendation.
- A multistage, online, semi-blinded iterative review process then refined each section.
- The section manuscripts were then combined into a cohesive single document.
- The entire manuscript was then reviewed by all authors for consensus.
For Further Reading
- Bhattacharyya N, Kepnes LJ. Patterns of care before and after the adult sinusitis clinical practice guideline. Laryngoscope. 2013;123:1588–1591.
- Alt JA, Smith TL, Mace JC, Soler ZM. Sleep quality and disease severity in patients with chronic rhinosinusitis. Laryngoscope. 2013;123:2364–2370.
- Chung SD, Hung SH, Lin HC, Lin CC. Health care service utilization among patients with chronic rhinosinusitis: a population-based study. Laryngoscope. 2014;124:1285–1289.
- Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014;124:2007–2012.
- Remenschneider AK, D’Amico L, Gray ST, Holbrook EH, Gliklich RE, Metson R. The EQ-5D: a new tool for studying clinical outcomes in chronic rhinosinusitis. Laryngoscope. 2015;125:7–15.