Key Points Only instrument the frontal recess with good reason and sound intention. Functional drainage of the frontal sinus relies on preservation of the mucosa of the frontal recess. If the mucosa of the frontal recess cannot be preserved, a…
Key Points Primary functional endoscopic sinus surgery (FESS) is an effective technique for relieving sinus ostial obstruction, removing osteitic bony partitions, decreasing inflammatory burden, and preparing the nasal cavity for topical medications. The initial surgery represents the greatest chance for…
Key Points Primary surgery for chronic rhinosinusitis is almost exclusively performed endoscopically. Functional endoscopic sinus surgery (FESS) aims to restore mucociliary function by reestablishing physiologic sinus ventilation and drainage. Surgery should be personalized. The extent of surgery depends on symptoms…
Key Points Outcomes research for chronic rhinosinusitis (CRS) has evolved significantly over the last decade. Although many types of outcome measures exist, patient-reported outcomes measures (PROMs) are currently the most commonly used metrics. The 22-question Sinonasal Outcomes Test (SNOT-22) has…
Key Points Strongly Recommended Therapies High volume saline irrigations and topical intranasal corticosteroids are supported by a strong recommendation for the treatment of chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP). Recommended Therapies Nonstandard delivery of topical intranasal…
Key Points Chronic rhinosinusitis (CRS) comprises a group of disorders that arise from complex inflammatory processes triggered by the interaction between an array of environmental agents and the host mucosal immune system. CRS is overwhelmingly idiopathic; however, few patients have…
Key Points Understanding the pathogenesis of rhinosinusitis depends on defining the specific types of rhinosinusitis. Acute bacterial rhinosinusitis (ABRS), chronic rhinosinusitis (CRS), and acute exacerbation of chronic rhinosinusitis (AECRS) are three distinct entities. A number of environmental and host factors…
Key Points Nonallergic rhinitis (NAR) is a chronic, highly prevalent condition that presents with symptoms of nasal congestion, obstruction, and rhinorrhea in the setting of a negative allergen test. In contrast to allergic rhinitis (AR), NAR has a greater predilection…
Key Points The diagnosis of acute rhinosinusitis is made on clinical grounds, and imaging is reserved for cases with suspected intracranial and orbital complications. Computed tomography (CT) is the modality of choice in imaging of chronic rhinosinusitis (CRS) and planning…
Key Points Ciliary activity causes the transport of mucus in the airways, an essential defense mechanism of the respiratory tract. Mucociliary transport can be measured in vivo either by using the saccharine and/or color test or by radioisotope transport testing,…