Research Gaps - Adult Sinusitis

Research needs are as follows: 
  1. Define the natural history and management of subacute rhinosinusitis. 
  2. Determine the validity of diagnosing ABRS by patient history without confirmatory physical examination. 
  3. Refine and validate diagnostic criteria for VRS and ABRS. 
  4. Assess the validity of diagnosing ABRS before 10 days based on persistent fever plus concurrent purulent nasal discharge.
  5. Determine whether a diagnostic algorithm tool would change physician behavior in terms of antibiotic prescription practices. 
  6. Assess the value of viral screening methods in the routine management of patients with suspected ABRS. 
  7. Conduct clinical trials to determine the efficacy of an "observation option" for nonsevere ABRS, by randomizing patients to immediate vs delayed antibiotics and assessing clinical outcomes.  
  8. Standardize the definition of "severe" illness in patients diagnosed with ABRS. 
  9. Conduct randomized controlled trials with superiority design that emphasize time to improvement/resolution, not just binary outcomes at fixed time points.  
  10. Perform RCTs of antibiotic vs placebo for ABRS in settings other than primary care, including emergency rooms and specialist offices. 
  11. Evaluate the role of analgesic therapy in managing rhinosinusitis and the comparative efficacy of different drug classes.
  12. Assess the benefits of symptomatic therapy for VRS in properly conducted RCTs. 
  13. Assess the benefits of symptomatic therapy for ABRS in properly conducted RCTs. 
  14. Determine optimum salinity, pH, and regimen for administering nasal saline irrigation. 
  15. Devise strategies or treatment regimens to avoid the rebound effect of topical nasal decongestants. 
  16. Determine the comparative clinical efficacy of antibiotics for culture-proven ABRS using RCTs with standardized, uniform definitions of clinical disease, severity, and clinical outcomes. 
  17. Conduct RCTs to determine the benefits of efficacy of adjuvant therapy (nasal steroids, antihistamines, decongestants) in combination with antibiotics. 
  18. Acquire more evidence of which patients with ABRS are most suited for short-course antibiotic regimens. 
  19. Perform RCTs examining antibiotic efficacy among patient subpopulations; efficacy of fluoroquinolones relative to other antibiotics. 
  20. Include quality-of-life measures as study outcomes in RCTs. 
  21. Further assess the diagnosis of CRS and recurrent acute rhinosinusitis in primary care settings, rather than specialty clinic settings such as allergy and/or otolaryngology practices, because of biased disease prevalence. 
  22. Conduct investigations to further characterize the role of fungi in the etiology of inflammation of the paranasal sinuses.
  23. Conduct investigations to determine the underlying cause of the inflammation that characterizes CRS and to determine the value of individualizing therapy based on this information. 
  24. Perform clinical trials to address outcomes of allergy management in patients with CRS or recurrent acute rhinosinusitis. 
  25. Perform clinical trials to address outcomes of detecting and managing immunodeficient states in patients with CRS or recurrent acute rhinosinusitis. 
  26. Validate nasal endoscopy scoring systems. 
  27. Assess the impact of intravenous immune globulin (IVIG) on CRS or recurrent acute rhinosinusitis in patients with humoral immune deficiency. 
  28. Conduct longitudinal studies with comparable control groups to evaluate long-term benefits of adjunctive therapies in the secondary prevention of CRS and recurrent acute rhinosinusitis. 
  29. Perform quantitative studies evaluating the impact of healthy lifestyle changes such as smoking cessation, dietary modification, and exercise on CRS. 
  30. Conduct RCTs of saline nasal irrigations as short-term vs long-term treatment for recurrent acute and chronic rhinosinusitis.