European Position Paper on Rhinosinusitis and Nasal Polyps 2020
W.J. Fokkens, Valerie J. Lund, C. Hopkins, Peter W. Hellings, Robert C. Kern, Sietze Reitsma, Sanna Toppila‐Salmi, Manuel Bernal‐Sprekelsen, J Mullol, Isam Alobid, Wilma Terezinha Anselmo‐Lima, Claus Bachert, Fuad M. Baroody, Christian von Buchwald, Anders Cervin, Natalie R. Cohen, J. Constantinidis, L. de Gabory, Martin Desrosiers, Zuzana Diamant, Richard Douglas, Philippe Gevaert, Anne‐Sophie Hafner, Richard J. Harvey, Guy Joos, Livije Kalogjera, Andrew Knill, Janwillem Kocks, Basile N. Landis, Jacqueline Limpens, Sarah Lebeer, Olga Lourenço, P.M. Matricardi, Cem Meço, Liam O’Mahony, Carl Philpott, Dermot Ryan, Ralf G.M. Schlösser, Brent A. Senior, Timothy L. Smith, Thijs Teeling, Peter Valentin Tomazic, D.Y. Wang, De Yun Wang, L Zhang, Adrian M. Agius, Cecilia Ahlström‐Emanuelsson, Rashid bin Yahya Al-Abri, Silviu Albu, Saied Alhabash, Aleksandra Aleksić, Mohammad Aloulah, Mohannad Al‐Qudah, Saad Alsaleh, Muaid I. Aziz Baban, Tomislav Baudoin, T Balvers, Paolo Battaglia, David Bedoya, Achim G. Beule, Khaled Mohamed Bofares, Irwin M. Braverman, Eliza Brożek-Mądry, B Richard, C. A. Callejas, Sean Carrie, Lisa Caulley, Desderius Chussi, Eugenio De Corso, A. Coste, L. Devyani, Usamah Hadi, Ahmaed Elfarouk, P.H. Eloy, Shokrollah Farrokhi, Giovanni Felisati, M.D. Ferrari, Roman Fishchuk, J.W. Grayson, P.M. Goncalves, Boris Grdinić, V Grgic, A.W. Hamizan, J.V. Heinichen, Salina Husain, T.I. Ping, Justinas Ivaška, Frodita Jakimovska, Ljiljana Jovančević, Emily Kakande, Rasha Kamel, Sergey Karpischenko, H.H. Kariyawasam, Jens Kjeldsen, L. Klimek, S.W. Kim, J.J. Letort, Lopatin As, A Mahdjoubi, J Netkovski
Abstract
Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we can make progress with research in this area. Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), +/- facial pain/pressure, +/- reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from middle meatus and/or; oedema/mucosal obstruction primarily in middle meatus, and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses. The paper gives different definitions for epidemiology, first line and second line treatment and for research. Furthermore the paper describes the anatomy and (patho)physiology, epidemiology and predisposing factors, inflammatory mechanisms, evidence based diagnosis, medical and surgical treatment in acute and chronic rhinosinusitis and nasal polyposis in adults and children. Evidence based schemes for diagnosis and treatment are given for the first and second line clinicians. Moreover attention is given to complications and socio-economic cost of chronic rhinosinusitis and nasal polyps. Last but not least the relation to the lower airways is discussed.