Management of chronic rhinosinusitis

#### Summary points Chronic rhinosinusitis (CRS) is a common medical condition presenting to the primary care physician. The 2012 update of the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) reported that it may affect between 5% and 15% of the population in Europe and the United States, although high quality epidemiological data is scarce.1A multicentre questionnaire survey of adults in Europe estimated that one in ten participants had CRS but with notable geographic variation.2 Prevalence estimates for nasal polyps are difficult to achieve given the need for nasal endoscopy for a reliable diagnosis—questionnaire data may overestimate the prevalence of nasal polyps.3 One American study analysing a multiemployer database from 1991 ranked sinusitis as the ninth most costly health condition.4 #### Sources and selection criteria We searched Medline, the Cochrane Library, and PubMed using the search terms “chronic rhinosinusitis”, “rhinosinusitis”, “rhinitis”, “sinusitis”, “chronic disease”, and “nasal polyps”. We also referenced expert position papers such as the European Position Paper on Rhinosinusitis and Nasal Polyps.1 When possible, we used level I evidence from systematic reviews or randomised controlled trials. Rhinosinusitis is the appropriate term used to describe the common concurrence of inflammation and infection within the nasal passages and paranasal sinuses.5 The EP3OS taskforce (a group of international experts who appraise and report on the available literature) developed a clinical definition of rhinosinusitis that is based on the Allergic Rhinitis and its Impact on Asthma (ARIA) group guidelines (box 1).1 …