REVIEW – May 2012

Rhinosinusitis – from symptoms to diagnosis and treatment


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Current international guidelines provide health care professionals with a homogenous approach to the diagnosis and treatment of acute rhinosinusitis (ARS). The efficacy of intranasal steroids and antibiotics in the treatment of ARS has been consistently evidenced in severe cases. As the vast majority of ARS cases are of viral origin and require no treatment, prescribing of antibiotics should be reduced.

As chronic rhinosinusitis (CRS) is of a heterogenous origin, consensus on guidelines and initiatives is much more complicated to reach. Up to date, the pathophysiology of CRS is not fully clarifi ed and no treatment option from the evidence category 1A is available. In the diagnostic phase of CRS, an endoscopic method has growing importance; the symptoms of CRS are exclusively not suffi cient. The CT-scan is an important informative method in diff erentiating CRS patients from cases with CRS-like symptoms. Current guidelines do not standardise recommendations for surgical treatment or principles of patient selection. Recently, the pathogenesis and phenotyping of CRS have been taken account in designing trials; this can eventually lead to a new universal management approach in CRS.