Diagnosis and management of chronic rhinosinusitis in adults

Bradley F. Marple, James A. Stankiewicz, Fuad M. Baroody, James M. Chow, David B. Conley, Jacqueline P. Corey, Berrylin J. Ferguson, Robert C. Kern, Rodney P. Lusk, Robert M. Naclerio, Richard R. Orlandi, Michael J. Parker

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofllm formation. gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored posmasal discharge; hyposmia/anosmia; facial pain and/or pressure) and thcir duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians. and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.

Original languageEnglish (US)
Pages (from-to)121-139
Number of pages19
JournalPostgraduate Medicine
Volume121
Issue number6
DOIs
StatePublished - Nov 2009

Fingerprint

Nose
Physical Examination
Nasal Polyps
Nasal Obstruction
Paranasal Sinuses
Sinusitis
Inflammation
Endoscopy
History
Rhinitis, Allergic, Perennial
Olfaction Disorders
Superantigens
Turbinates
Facial Pain
Nasal Cavity
Environmental Exposure
Primary Care Physicians
Blister
Gastroesophageal Reflux
Pharynx

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Marple, B. F., Stankiewicz, J. A., Baroody, F. M., Chow, J. M., Conley, D. B., Corey, J. P., ... Parker, M. J. (2009). Diagnosis and management of chronic rhinosinusitis in adults. Postgraduate Medicine, 121(6), 121-139. https://doi.org/10.3810/pgm.2009.11.2081

Diagnosis and management of chronic rhinosinusitis in adults. / Marple, Bradley F.; Stankiewicz, James A.; Baroody, Fuad M.; Chow, James M.; Conley, David B.; Corey, Jacqueline P.; Ferguson, Berrylin J.; Kern, Robert C.; Lusk, Rodney P.; Naclerio, Robert M.; Orlandi, Richard R.; Parker, Michael J.

In: Postgraduate Medicine, Vol. 121, No. 6, 11.2009, p. 121-139.

Research output: Contribution to journalArticle

Marple, BF, Stankiewicz, JA, Baroody, FM, Chow, JM, Conley, DB, Corey, JP, Ferguson, BJ, Kern, RC, Lusk, RP, Naclerio, RM, Orlandi, RR & Parker, MJ 2009, 'Diagnosis and management of chronic rhinosinusitis in adults', Postgraduate Medicine, vol. 121, no. 6, pp. 121-139. https://doi.org/10.3810/pgm.2009.11.2081
Marple BF, Stankiewicz JA, Baroody FM, Chow JM, Conley DB, Corey JP et al. Diagnosis and management of chronic rhinosinusitis in adults. Postgraduate Medicine. 2009 Nov;121(6):121-139. https://doi.org/10.3810/pgm.2009.11.2081
Marple, Bradley F. ; Stankiewicz, James A. ; Baroody, Fuad M. ; Chow, James M. ; Conley, David B. ; Corey, Jacqueline P. ; Ferguson, Berrylin J. ; Kern, Robert C. ; Lusk, Rodney P. ; Naclerio, Robert M. ; Orlandi, Richard R. ; Parker, Michael J. / Diagnosis and management of chronic rhinosinusitis in adults. In: Postgraduate Medicine. 2009 ; Vol. 121, No. 6. pp. 121-139.
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