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The body of knowledge regarding rhinosinusitis(RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS).Evidence-based reviews with recommendations(EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR)was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus.The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS)with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AECRS), and pediatric RS.As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too often the foundation upon which these recommendations are based is comprised of lower level evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed.

Evidence-based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes.Double-blinded prospective (level 1) comparison and equivalency analysis of three plant-based absorbable hemostatic agents (carboxymethylcellulose [CMC] gel, mucopolysaccharide hemospheres (MPH), and potato starch wafer) in patients undergoing bilateral ESS.Patients with medically refractory CRS who underwent bilateral ESS were recruited and prospectively followed. At the conclusion of ESS, one of three different hemostatic agents was applied to each nasal passage. Subjective patient data was obtained using rated symptoms compared between the two sides (nasal obstruction, bleeding, pain, and nasal discharge) at baseline and on postoperative days 1, 7, and 14. Objective data was obtained by blinded endoscopic scoring to rate mucosal edema, inflammation, granulation, crusting, infection, and synechiae formation on postoperative weeks 1, 3, and 6.Forty-eight patients who underwent ESS for CRS were included. There is no statistical difference in subjective scores for any of the variables measured, although (MPH) nearly reached statistical significance at postoperative day 7 for increased pain (P = 0.06) and obstruction (P = 0.22). Objective measures showed equivalency between all products, except the CMC gel approached significance at week 3 for increased crusting (P = 0.10), granulation (P = 0.24), and debridement (P = 0.07). At 6 weeks, increased debridement (P = 0.14) also approached significance.Careful and deliberate consideration should be taken when choosing products to assist our surgical endeavors. Subjectively, patients treated with MPH showed near-significant increases in pain and obstruction. In objective measures, CMC gel nearly reaches significance for more postoperative debridement, with increased crusting and inflammation. Product choice could consider these factors, although it remains at the discretion of the surgeon. This model of comparison allows careful product comparison and should be applied to other hemostatics, as well as other materials in use in otolaryngology.1b. Laryngoscope, 126:S5-S13, 2016.

The Sinonasal Outcomes Test-20 (SNOT-20) is a validated tool to assess treatment outcomes in patients with chronic rhinosinusitis (CRS). In the clinic, we observed that patients who responded with a positive score on all 20 items of the SNOT-20 questionnaire (pan-positive patients) often did not have evidence of CRS upon workup. Many of these patients had other underlying diseases contributing to their complaints.Analysis of prospectively collected data was performed to identify SNOT-20 pan-positive patients and compare them to 100 consecutive non-pan-positive patients who served as the control group. The following parameters were compared between the two patient groups: presence or absence of chronic diseases such as obstructive sleep apnea, depression, anxiety, fibromyalgia, chronic pain, headaches, temporomandibular joint disease, and arthritis--in addition to sinus computed-tomography Lund-McKay scores and nasal endoscopy Lund-Kennedy scores. We also reviewed the medication list of each patient to look for the possible presence of mental illness. Statistical analysis was performed using the chi-squared and Student t test.One hundred twenty-two pan-positive patients were identified in our database collected from 2003 to 2011. Pan-positive patients had higher incidence of depression, fibromyalgia, anxiety, pain, headache, and use of depression medications--and they also had higher SNOT-20 and endoscopy scores when compared to controls (P0.05). Pan-positive patients were more likely female (P0.05), but age and race differences did not reach statistical significance.The SNOT-20 questionnaire assists clinicians to monitor outcomes in patients treated for CRS. However, clinicians should suspect other underlying chronic conditions in SNOT-20 pan-positive patients.3B.

H ΣΥΓΓΕΝΗΣ ΜΙΚΡΩΤΙΑ ΔΙΑΙΡΕΙΤΑΙ ΣΕ 3 ΒΑΘΜΟΥΣ ΣΥΜΦΩΝΑ ΜΕ ΤΟΝ MARX. Ο ΒΑΘΜΟΣ Ι ΧΑΡΑΚΤΗΡΙΖΕΙ ΤΗΝ ΗΠΙΑ ΑΝΩΜΑΛΙΑ, Ο ΒΑΘΜΟΣ ΙΙΙ ΤΗΝ ΣΟΒΑΡΗ ΑΝΩΜΑΛΙΑ ΚΑΙ Ο ΒΑΘΜΟΣ ΙΙ ΤΗΝ ΕΝΔΙΑΜΕΣΗ. ΕΧΕΙ ΑΝΑΠΤΥΧΘΕΙ ΣΥΣΤΗΜΑ ΤΑΞΙΝΟΜΙΣΗΣ ΓΙΑ ΤΗ ΣΥΓΓΕΝΗ ΑΤΡΗΣΙΑ ΤΟΥΕΞΩ ΑΚΟΥΣΤΙΚΟΥ ΠΟΡΟΥ, ΒΑΣΙΣΜΕΝΟ ΣΤΗΝ ΥΠΟΛΟΓΙΣΤΙΚΗ ΤΟΜΟΓΡΑΦΙΑ ΤΟΥ ΚΡΟΤΑΦΙΚΟΥ ΟΣΤΟΥ ΚΑΙ ΤΗΝ ΕΜΦΑΝΙΣΗ ΤΟΥ ΕΞΩ ΩΤΟΣ. Η ΒΑΘΜΟΛΟΓΙΑ ΚΥΜΑΙΝΕΤΑΙ ΑΠΟ ΜΗΔΕΝ ΕΩΣ ΔΕΚΑ, ΟΠΟΥ ΤΟ ΔΕΚΑ ΔΗΛΩΝΕΙ ΕΞΑΙΡΕΤΕΣ ΠΡΟΟΠΤΙΚΕΣ ΓΙΑ ΤΗΝ ΒΕΛΤΙΩΣΗ ΤΗΣ ΑΚΟΗΣ ΚΑΙ ΤΟ5 Η ΛΙΓΟΤΕΡΟ ΔΗΛΩΝΕΙ ΧΑΜΗΛΕΣ ΠΡΟΟΠΤΙΚΕΣ ΤΟΥ ΥΠΟΨΗΦΙΟΥ ΓΙΑ ΕΠΙΤΥΧΗ ΧΕΙΡΟΥΡΓΙΚΗΕΠΕΜΒΑΣΗ. ΕΞΕΤΑΣΑΜΕ ΤΑ ΙΣΤΟΡΙΚΑ 230 ΑΣΘΕΝΩΝ (291 ΩΤΑ) ΑΠΟ ΤΟ 1998 ΕΩΣ ΤΟ 1992. Ο ΜΕΣΟΣ ΟΡΟΣ ΒΑΘΜΟΛΟΓΙΑΣ ΤΗΣ ΑΤΡΗΣΙΑΣ ΗΤΑΝ 8,5 ΓΙΑ ΤΗ ΜΙΚΡΩΤΙΑ ΒΑΘΜΟΥ Ι,7,2 ΓΙΑ ΤΗ ΜΙΚΡΩΤΙΑ ΒΑΘΜΟΥ ΙΙ ΚΑΙ 5,9 ΓΙΑ ΤΗ ΜΙΚΡΩΤΙΑ ΒΑΘΜΟΥ ΙΙΙ. ΣΤΟΥΣ ΑΣΘΕΝΕΙΣ ΜΕ ΣΥΓΓΕΝΗ ΑΤΡΗΣΙΑ ΤΟΥ ΕΞΩ ΑΚΟΥΣΤΙΚΟΥ ΠΟΡΟΥ Η ΕΜΦΑΝΙΣΗ ΤΟΥ ΕΞΩ ΩΤΟΣ ΣΥΣΧΕΤΙΖΕΤΑΙ ΚΑΛΑ ΜΕ ΤΗΝ ΑΝΑΠΤΥΞΗ ΤΟΥ ΜΕΣΟΥ ΩΤΟΣ. ΣΕ 147 ΩΤΑ, Ο ΒΑΘΜΟΣ ΜΙΚΡΩΤΙΑΣ ΗΤΑΝ ΓΝΩΣΤΟΣ ΚΑΙ ΥΠΗΡΧΕ ΣΤΟΥΣ ΦΑΚΕΛΟΥΣ ΥΠΟΛΟΓΙΣΤΙΚΗ ΤΟΜΟΓΡΑΦΙΑ ΥΨΗΛΗΣ ΕΥΚΡΙΝΕΙΑΣ ΤΟΥ ΚΡΟΤΑΦΙΚΟΥ ΟΣΤΟΥ. ΑΠΟ ΑΥΤΑ, 84 ΕΙΧΑΝ ΧΕΙΡΟΥΡΓΗΘΕΙ ΓΙΑ ΑΠΟΚΑΤΑΣΤΑΣΗ ΤΗΣ ΑΚΟΗΣ. ΣΕ ΛΙΓΕΣ ΠΕΡΙΠΤΩΣΕΙΣ Η ΑΡΘΡΩΣΗ ΑΚΜΟΝΑ-ΑΝΑΒΟΛΕΑ ΔΕΝ ΔΙΑΚΡΙΝΟΤΑΝ ΚΑΛΑ ΣΤΗΝ ΥΠΟΛΟΓΙΣΤΙΚΗ ΤΟΜΟΓΡΑΦΙΑ, ΑΝΑΓΝΩΡΙΣΤΗΚΕ ΟΜΩΣ ΣΤΟ ΧΕΙΡΟΥΡΓΕΙΟ. ΣΕ ΑΡΚΕΤΕΣ ΠΕΡΙΠΤΩΣΕΙΣ ΥΠΗΡΧΕ ΔΥΣΚΟΛΙΑ ΓΙΑΤΙ ΤΟ ΠΡΟΣΩΠΙΚΟ ΝΕΥΡΟ ΗΤΑΝ ΠΑΡΕΚΤΟΠΙΣΜΕΝΟ ΠΡΟΣΘΙΑ, ΚΑΤΑ ΤΗ ΔΙΑΡΚΕΙΑ ΟΜΩΣ ΤΟΥ ΧΕΙΡΟΥΡΓΕΙΟΥ ΔΕΝ ΕΜΠΟΔΙΣΤΗΚΕ Η ΕΠΕΜΒΑΣΗ ΚΑΙ ΤΟ ΤΕΛΙΚΟ ΑΠΟΤΕΛΕΣΜΑ ΗΤΑΝ ΚΑΛΟ. Η ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΔΙΟΡΘΩΜΕΝΗ ΒΑΘΜΟΛΟΓΙΑ ΗΤΑΝ 8,9 ΓΙΑ ΒΑΘΜΟ ΜΙΚΡΩΤΙΑΣ Ι, 7,8 ΓΙΑ ΒΑΘΜΟ ΙΙ ΚΑΙ 6,1 ΓΙΑ ΒΑΘΜΟ ΙΙΙ. Η ΔΙΑΦΟΡΑ ΔΕΝ ΗΤΑΝ (ΠΕΡΙΚΟΠΗ ΠΕΡΙΛΗΨΗΣ)