Patients who would benefit most from surgery and are least likely to benefit from continued medical therapy alone should be identified
By Elana Gotkine HealthDay Reporter
MONDAY, June 2, 2025 (HealthDay News) — In a new clinical practice guideline issued by the American Academy of Otolaryngology-Head and Neck Surgery Foundation and published online May 27 in Otolaryngology-Head and Neck Surgery, recommendations are presented for the surgical management of chronic rhinosinusitis in adults.
Jennifer J. Shin, M.D., from Harvard Medical School in Boston, and colleagues developed 11 key action statements to aid clinicians in the surgical management of chronic rhinosinusitis in adults.
According to the guideline, the surgeon should verify an existing diagnosis of chronic rhinosinusitis before considering surgery. For an adult with chronic rhinosinusitis, the surgeon should not endorse or require a predefined regimen or duration of medical therapy as a prerequisite to sinus surgery. Patients who will benefit most from surgery and are least likely to benefit from continued medical therapy alone, such as those with chronic rhinosinusitis subtypes that include chronic rhinosinusitis with polyps, polyps with bony erosion, eosinophilic mucin, or fungal balls, should be identified.
The guideline authors also recommend establishing realistic expectations by counseling patients before surgery; these include the potential for chronicity or relapse and the likelihood of long-term medical management. The surgeon should obtain a computed tomography (CT) scan with a fine-cut protocol to examine the paranasal sinuses for surgical planning for an adult who is a candidate for surgery. The extent of surgery should not be planned solely based on arbitrary criteria regarding minimal level of mucosal thickening, sinus opacification, or outflow obstruction on CT scan. Adults who are scheduled for sinus surgery should be educated regarding anticipated postoperative care, including pain control.
“This clinical practice guideline provides the guidance for developing the needed care pathways for patients who may undergo surgery for chronic rhinosinusitis, based on current best evidence,” Shin said in a statement.
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