A multidisciplinary panel of experts released new clinical recommendations on when and how to surgically treat chronic rhinosinusitis in adults.
The guideline aims to reduce practice variation, prevent unnecessary procedures, and support effective care through evidence-based standards.
Chronic rhinosinusitis (CRS) affects an estimated 11% to 12% of U.S. adults. Symptoms include nasal obstruction, facial pain or pressure, thick nasal drainage, and reduced sense of smell lasting at least 12 weeks. Diagnosis requires objective evidence of sinus inflammation, such as findings on nasal endoscopy or CT imaging.
Endoscopic sinus surgery (ESS) is a common treatment, especially when medical therapy fails. However, regional differences in ESS rates—up to fourfold in some areas—have prompted efforts to standardize decision-making.
The guidelines recommend that clinicians confirm patients meet diagnostic criteria for CRS before considering surgery. In addition to symptoms and imaging, clinicians should evaluate quality of life and prior treatment history. Tools such as the 22-item SinoNasal Outcome Test (SNOT-22) and CRS-PRO can help assess disease burden.
The guidelines also advise treatment decisions should be individualized. Surgery may be more beneficial for certain CRS subtypes, including those with nasal polyps, bony erosion, eosinophilic mucin, or fungal balls—conditions less likely to improve with medical therapy alone.
For surgical planning, a fine-cut CT scan is recommended if not already performed. However, the extent of surgery should not rely solely on imaging features such as mucosal thickening or sinus opacification. Surgeons are also encouraged to educate patients about postoperative care, recovery, and the possibility of recurrence or revision procedures.
Long-term follow-up is essential. Between 3 and 12 months postoperatively, clinicians should assess outcomes using symptom history and nasal endoscopy. Evaluations should include symptom relief, adherence to care, and the need for further treatment.
The guidelines also addressed disparities in access and outcomes. Non-White patients were more likely to require revision surgery and present with more severe disease. Socioeconomic status and insurance coverage were identified as contributing factors, highlighting the importance of equitable care.
ESS has been shown to improve sleep, reduce fatigue, and enhance productivity in patients with refractory CRS. Although risks include bleeding, infection, and rare major complications, untreated CRS may result in bone erosion, intracranial spread, or worsened asthma.
By prioritizing accurate diagnosis, individualized treatment, and patient education, the guideline seeks to improve the safety and effectiveness of surgical care for chronic sinusitis. A review is scheduled within five years or earlier if new evidence emerges.
Full disclosures can be found in the study.