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CPG: Adult Sinusitis Update

CPG: Adult Sinusitis Update

The guideline update group identified knowledge gaps based on existing practice patterns and the scope and quality of supporting literature. We present these gaps below to highlight areas for future research and investigation.

  1. Refine and validate diagnostic criteria for VRS and ABRS.
  2. Determine the validity of diagnosing ABRS by patient history without confirmatory physical examination.
  3. Assess the validity of diagnosing ABRS before 10 days based on persistent fever plus concurrent purulent nasal discharge.
  4. Standardize the definition of “severe” illness in patients diagnosed with ABRS and determine whether it is a valid and useful distinction for diagnosis in adults.
  5. Evaluate the role of analgesic therapy in managing rhinosinusitis and the comparative efficacy of different drug classes.
  6. Assess the benefits of symptomatic therapy for VRS in properly conducted RCTs.
  7. Assess the benefits of various symptomatic therapies for ABRS in properly conducted RCTs.
  8. Confirm previous findings regarding optimum salinity, pH, and regimen for administering nasal saline irrigation.
  9. Assess the impact of clinician beliefs about antibiotic prescribing for ABRS and how they might affect patient preferences and satisfaction.
  10. Conduct RCTs with superiority design that emphasize time to improvement/resolution, not just binary outcomes at fixed time points.
  11. Perform RCTs of antibiotics vs placebo using strict diagnostic criteria and stratify by clinical severity (ie, mild, moderate, or severe).
  12. Perform RCTs to assess the comparative efficacy of different antibiotics for initial management of uncomplicated ABRS.
  13. Conduct RCTs to determine the efficacy of adjuvant therapy (nasal steroids, antihistamines, decongestants) in combination with antibiotics.
  14. Obtain greater evidence for which ABRS patients are most appropriate for short-course antibiotic regimens.
  15. Perform RCTs examining antibiotic efficacy among various patient subpopulations.
  16. Include quality-of-life and other patient-reported outcome measures as study outcomes in RCTs.
  17. Further assess the diagnosis of CRS and recurrent acute rhinosinusitis in primary care settings, rather than specialty clinic settings, because of biased disease prevalence.
  18. Conduct investigations to determine the underlying causes of the inflammation that characterizes CRS and to determine the value of individualizing therapy based on this information.
  19. Determine how symptoms and QOL scores correlate to objective findings in adult CRS patients.
  20. Perform scoping review of the diagnostic criteria for CRS from international papers, including differences, consistencies and best practices among the different diagnostic criteria.
  21. Determine what features (exam, symptoms) are most predictive of paranasal sinus disease/CRS and should initiate an otolaryngology referral?
  22. Conduct longitudinal studies to look at effects of different therapies (medical and surgical) over time. What sinonasal diseases or symptoms can be cured vs. controlled?
  23. Determine a best overall care plan that includes surgery and biologic medications.
  24. Investigate which modes of education promote the highest level of compliance with or adherence to the entire treatment plan.
  25. Conduct long term studies to evaluate the effects of macrolide antibiotics for CRS treatment and help determine a recommended treatment length and risk profile.
  26. Determine the pathogenesis of CRS and the association of allergic rhinitis and CRS.
  27. Establish the benefit of testing for allergy and immune function in subgroups of patients with CRS.
  28. Perform RCTs to address outcomes of allergy management in patients with CRS or recurrent acute rhinosinusitis.
  29. Perform RCTs to address outcomes of detecting and managing immunodeficient states in patients with CRS or recurrent acute rhinosinusitis.
  30. Validate nasal endoscopy scoring systems.
  31. Assess the impact of intravenous immonoglobulin (IVIG) on CRS or recurrent acute rhinosinusitis in patients with humoral immune deficiency.
  32. 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.
  33. Perform quantitative studies evaluating the impact of healthy lifestyle changes, such as smoking cessation, dietary modification, and exercise on CRS.
  34. Conduct RCTs of saline nasal irrigations as short-term vs long-term treatment for recurrent acute and CRS.
  35. Define what is optimal medical therapy, including the efficacy of certain medications over others and the amount of time required for treatment.
  36. Further assess the cost-effectiveness of management strategies for CRS and their impact on resource utilization and patient quality of life.
  37. Perform additional RCTs to clarify the impact of antibiotic therapy on CRS outcomes.
  38. Evaluate the optimal use of biologicals with respect to outcomes, costs and timing related to surgery.
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