American Rhinologic Society Member Survey on “Maximal Medical Therapy” for Chronic Rhinosinusitis

2007 ◽  
Vol 21 (4) ◽  
pp. 483-488 ◽  
Author(s):  
Marc G. Dubin ◽  
Cindy Liu ◽  
Sandra Y. Lin ◽  
Brent A. Senior
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Demographic Data ◽  
Standard Of Care ◽  
Oral Antibiotics ◽  
Saline Irrigation ◽  
Frequency Of Use ◽  
Nasal Steroids ◽  
Oral Steroids ◽  
Maximal Medical Therapy

Background “Maximal medical therapy” is the standard of care for chronic rhinosinusitis (CRS) treatment before the recommendation for surgery. However, this therapy is not consistent. Therefore, as a first step in determining the role of the disparate “maximal medical” treatments for CRS, American Rhinologic Society (ARS) members were surveyed. Methods A survey was mailed to all nonresident members of the ARS (n = 723). Focusing on the time period before surgical intervention is first considered for CRS patients, the survey assessed types of therapies, frequency of use, details on antibiotic and steroid usage, use of computed tomography (CT), and demographic data of respondents. All responses were anonymous. Results Three hundred eight surveys were returned (43%). A majority of respondents used oral antibiotics and nasal steroids “almost always (>90%).” Oral antibiotics, oral steroids, nasal steroids, saline irrigation, and allergy testing were most commonly used at least “usually (50–90%).” The median antibiotic length was 3.1–4 weeks. The mean peak prednisone dose was 51.7 mg when oral steroids were used. Therapies that were rarely or never used by the majority included oral antifungals, antifungal spray, antibiotic spray, antibiotic nebulizer, steroid nebulizer, and i.v. antibiotics. Conclusion Oral antibiotics (median, 3.1–4 weeks) and nasal steroids are used >90% of the time by a majority of ARS members for maximal medical treatment of CRS.

scholarly journals Maximal Medical Therapy for Chronic Rhinosinusitis: A Survey of Chinese Otolaryngologists

2019 ◽  
Vol 99 (3) ◽  
pp. 159-164
Author(s):  
Zhenxiao Huang ◽  
Jingying Ma ◽  
Yan Sun ◽  
Bing Zhou
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Practice Patterns ◽  
Demographic Data ◽  
Sinus Surgery ◽  
Oral Antibiotics ◽  
Intranasal Corticosteroid ◽  
Saline Irrigation ◽  
Frequency Of Use ◽  
Maximal Medical Therapy

The aim of the present study was to evaluate the clinical practice patterns in maximal medical therapy (MMT) before endoscopic sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists. An anonymous web-based survey of MMT was performed. This survey assessed types of therapies, the frequency of use, duration of use, and demographic data of respondents. A total of 134 (26.8%) questionnaires were completed and returned. The majority (62.69%) of respondents would consider surgery less than 3 months after commencing MMT, 33.58% would wait 3 to 6 months. Intranasal corticosteroid sprays, saline irrigation, oral antibiotics, oral mucolytics, and oral Chinese herbals were the most commonly used therapies and listed as “often (>70%)”. Macrolides were most commonly antibiotics prescribed among the clinicians surveyed (51.49%). Intranasal corticosteroid sprays, oral antibiotics, oral mucolytics, nasal saline irrigations, and oral Chinese herbals are most commonly prescribed by the majority of Chinese otolaryngologists as MMT for CRS. Current practice patterns of MMT among Chinese otolaryngologists are not uniformly based on evidence-based guidelines.

Efficacy of Targeted Medical Therapy in Chronic Rhinosinusitis, and Predictors of Failure

2009 ◽  
Vol 23 (4) ◽  
pp. 396-400 ◽  
Author(s):  
Devyani Lal ◽  
Joseph M. Scianna ◽  
James A. Stankiewicz
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Mucosal Inflammation ◽  
Pressure Pain ◽  
Factors Associated ◽  
Severity Grade ◽  
Nasal Steroids ◽  
Oral Steroids ◽  
History Of

Background No standardized medical therapy for chronic rhinosinusitis (CRS) is universally accepted. Success of medical therapy is reportedly 50% to 88%, but studies differ in inclusion criteria, medications, duration of therapy, and defining “success.” The objectives of this study were to determine efficacy of a standardized targeted medical therapy (TMT) regimen in CRS and to analyze factors associated with failure of therapy. Methods Retrospective analysis of prospectively collected data was performed. CRS was diagnosed based on CRS Taskforce guidelines. TMT was defined as a minimum 4-week treatment with oral antibiotics, oral steroids, topical nasal steroids, topical nasal decongestant rotation, and saline nasal douching. “Failure” was defined as relapse/persistence of signs/symptoms or need for surgery. One hundred forty-five patients that received TMT, with a minimum 2-month follow-up, were identified. The results of therapy were reviewed to determine efficacy and analyze factors associated with failure. Results Seventy-four patients (51.03%) were successfully treated. Failures included 26 patients (17.8%) with only partial improvement and 45 (31.03%) who underwent surgery. Only history of facial pressure/pain (p = 0.049), presence of mucosal inflammation (p = 0.013), and higher endoscopic severity grade (p = 0.011) were associated with failure of TMT. Conclusions TMT was unequivocally successful in 51% of patients. Failures included 31% who underwent surgery and 18% with partial benefit. Surgery was avoided in 69%. Facial pressure/pain, mucosal inflammation, and higher endoscopic severity grade were associated with failure of medical therapy.

scholarly journals Study of the effect of balloon sinuplasty in patients with rhinosinusitis

2020 ◽  
Vol 6 (11) ◽  
pp. 2007
Author(s):  
Tanya Singh ◽  
Arjun Singh ◽  
Sarbjeet Singh
Keyword(s):  
Chronic Rhinosinusitis ◽  
Sinus Surgery ◽  
Saline Irrigation ◽  
Balloon Sinuplasty ◽  
Positive Biopsy ◽  
Intravenous Antibiotics ◽  
Nasal Steroids ◽  
Frontal Sinuses ◽  
A New Technique

<p class="abstract"><strong>Background:</strong> A new technique which has revolutionized sinus surgery recently is balloon sinuplasty. The vast majority of patients with chronic rhinosinusitis improve with medical management, including antibiotics, saline irrigation, nasal steroids, antihistamines, allergy therapy, and asthma control. This study was conducted to study the effect of balloon sinuplasty in patients affected with rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in all the patients visiting our hospital. Medical treatment included oral and sometimes intravenous antibiotics, nasal steroids, decongestants, systemic steroids, and allergy management. Those who had a positive biopsy were excluded from this study. The selected cohort of 20 patients, were prepared for balloon sinuplasty surgery in the same way as for conventional functional endoscopic sinus surgery (FESS) and were operated by our surgical team.  </p><p class="abstract"><strong>Results:</strong> 20 patients were included in the study, 70% men and aged 30±12 years. Sinuplasty was performed in 32 sinuses of 20 patients (22 maxillary, 4 sphenoid and 8 frontal sinuses).</p><p class="abstract"><strong>Conclusions:</strong> Sinuplasty with balloon catheterization is effective in reducing symptoms and improving quality of life in selected patients with chronic rhinosinusitis. The results are beyond reported symptoms and confirm the benefit of balloon sinuplasty.</p><p class="abstract"> </p>

scholarly journals Chronic rhinosinusitis: medical versus surgical management

2021 ◽  
Vol 7 (7) ◽  
pp. 1150
Author(s):  
Seema Patel ◽  
Tanvi S. Rekhade ◽  
Rameshwar T. Pawar ◽  
Ashok Z. Nitnaware
Keyword(s):  
Chronic Rhinosinusitis ◽  
Surgical Management ◽  
Medical Therapy ◽  
Medical Management ◽  
Nasal Polyposis ◽  
Individual Case ◽  
Treatment Modalities ◽  
The Difference ◽  
Maximal Medical Therapy ◽  
Snot 22

<p class="abstract"><strong>Background:</strong> Management protocols of chronic rhinosinusitis (CRS) recommend initial treatment with maximal medical therapy with surgery reserved for refractory cases. Literature comparing the effectiveness of these two treatment modalities is limited. The purpose of this study was to compare the outcome of medical and surgical management for CRS.</p><p class="abstract"><strong>Methods:</strong> This was a prospective cohort study. Patients registered for the study were diagnosed as CRS based on history, clinical examination and investigation findings. All patients were initially subjected to medical management for 3 weeks and refractory cases were then subjected to surgical intervention. Subjective and objective improvements assessed with SNOT-22 score and Lund-Kennedy (LK) score respectively were analysed statistically.</p><p class="abstract"><strong>Results:</strong> Out of the 100 patients registered for the study, 37% had nasal polyposis while 63% were without polyposis. When subjective and objective improvements were compared between groups receiving medical management alone and those receiving combined management, the difference was not found to be statistically significant (p&lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Although the decision regarding treatment modality to be used in CRS should depend on individual case, all cases can be subjected to a maximal medical therapy initially while reserving surgery for cases which do not improve.</p>

scholarly journals Long term oral azithromycin versus functional endoscopic sinus surgery in patients suffering from chronic rhinosinusitis: a comparative study

2021 ◽  
Vol 7 (6) ◽  
pp. 1015
Author(s):  
Garima Yadav ◽  
Mayank Yadav ◽  
Deeksha Nautiyal ◽  
T. S. Anand
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
Study Population ◽  
Maximal Medical Therapy ◽  
Objective Outcome ◽  
Oral Azithromycin

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal cavity and paranasal sinuses. Azithromycin, a macrolide antibiotic, a well-established class of anti-bacterial agents, which also have anti-inflammatory properties. The present study was designed to compare the role of azithromycin with surgical management in patients with chronic-rhinosinusitis.</p><p class="abstract"><strong>Methods: </strong>The study population included 60 adult patients with symptomatic CRS refractory to 3 weeks of medical therapy. The patients were divided in two groups with 30 patients in each group. One group of patients received oral Azithromycin as main treatment for 12 weeks while the other group of patients underwent sinonasal surgery. Symptom scoring and endoscopic scoring were done previous to the treatment and at 1 month and 3-month follow-ups.</p><p class="abstract"><strong>Results:</strong> A good subjective as well as objective outcome in terms of symptom improvement was obtained with in patients with chronic rhinosinusitis with Surgical intervention as compared to those patients who received long term oral Azithromycin.</p><p class="abstract"><strong>Conclusions: </strong>We advocate that patients suffering from chronic sinonasal disease should be initially targeted with maximal medical therapy using an oral macrolide for at least 3 months. After this patient should be assessed and surgery considered in those cases refractory to medical therapy.</p>

scholarly journals The Impact of Total Immunoglobulin E Levels on Outcomes of Maximal Medical Therapy for Chronic Rhinosinusitis

2017 ◽  
Vol 8 (1) ◽  
pp. ar.2017.8.0188
Author(s):  
Ana M. Lemos-Rodriguez ◽  
Zainab Farzal ◽  
Satyan B. Sreenath ◽  
Brian D. Thorp ◽  
Brent A. Senior ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Medical Therapy ◽  
Immunoglobulin E ◽  
Maximal Medical Therapy ◽  
The Impact ◽  
Total Immunoglobulin
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