Report May Change Diagnosis, Management of Chronic Rhinosinusitis

I think we may have known for a while that the great majority of cases of CRS were not infectious since CRS didn’t respond to repeated courses of antibiotics, said Dr. Slavin.

The allergy practice parameter update clearly indicates that simple acute bacterial rhinosinusitis can be treated by a primary care physician, but if it is recurrent or chronic rhinosinusitis, then it is best to refer to a specialist, said Dr. Osguthorpe.

The difference is that ENTs can treat the entire spectrum of CRS. We have the medical and surgical tools in our armamentarium so that patients only have to see one physician. It is important for all to realize that surgery is necessary only in a minority of CRS cases, said Dr. Osguthorpe.

New Surgical Approaches

Additionally, some otolaryngologists-head and neck surgeons may be changing the way they do surgery for patients with CRS, concentrating on removing only the very modest amount of tissue that actually obstructs a sinus, plus any inspissated mucous (as in allergic fungal rhinosinusitis) or polyps. This change is based on a study that appeared in the Journal of Allergy and Clinical Immunology and reports that nasal and sinus mucus from people with CRS contained activated eosinophils that produce a toxic protein that is elevated in the mucus, but not present in the tissue itself (J Allergy Clin Immunol. 2005; 116(2):362-369).

According to the authors of the allergy practice parameter, significant improvement for patients with CRS often requires a combination of appropriate surgical intervention with intensive postoperative local management to the region and appropriate medical therapy.

CRS: Fast Growing Area of Research

Based upon the culmination of these reports to date, Dr. Anon advises his otolaryngology colleagues to keep their antennas up, as CRS is a topic in progress and exciting new knowledge is constantly being learned and evaluated. For example, the allergy practice parameter update mentions other factors that might be associated with rhinosinusitis, such as gastroesophageal reflux disease (GERD), and a possible relationship between rhinosinusitis and otitis media or bronchial asthma.

Since Americans make more than 500,000 emergency department visits annually for CRS, according to the National Center for Health Statistics, keeping abreast of research on CRS and correctly identifying its causes in order to provide the most effective treatment is imperative for all physicians, regardless of specialty.

©2006 The Triological Society