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Leitlinie „Rhinosinusitis“ – Langfassung

S2-Leitlinie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Rhinosinusitis guidelines—unabridged version

S2 guidelines from the German Society of Otorhinolaryngology, Head and Neck Surgery

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Danksagung

Redaktionelle Unterstützung: cand. med. Franziska Lenz, Mannheim

Interessenkonflikt

Siehe Anhang, Kap. „Finanzierung und Interessenkonflikte“.

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Authors and Affiliations

  1. Universitäts-HNO-Klinik, 68135, Mannheim, Deutschland

    B.A. Stuck, L. Klimek, O. Pfaar & K. Hörmann

  2. Kliniek voor Neus-, Keel- & Oorheelkunde, UZ Gent, Gent, Belgien

    C. Bachert

  3. -, Homburg/Saar, Deutschland

    P. Federspil

  4. Klinik und Poliklinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf- und Halschirurgie, Greifswald, Deutschland

    W. Hosemann

  5. Zentrum für Rhinologie und Allergologie, Wiesbaden, Deutschland

    L. Klimek & O. Pfaar

  6. Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Köln, Deutschland

    R. Mösges

  7. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Münster, Deutschland

    C. Rudack

  8. Institut für Chirurgische Forschung, Marburg, Deutschland

    H. Sitter

  9. HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    M. Wagenmann

  10. Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    R. Weber

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  1. B.A. Stuck
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  8. C. Rudack
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  10. M. Wagenmann
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  11. R. Weber
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  12. K. Hörmann
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Corresponding author

Correspondence to B.A. Stuck.

Anhang

Anhang

Herausgeber: Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Stand: 01.03.2011

Revision: 3 Jahre nach Veröffentlichung, bei Erscheinen substanziell neuer Evidenzen ggf. früher

Verantwortlich für die Überarbeitung: Prof. Dr. med. Boris A. Stuck

Termine und Teilnehmer der nominalen Gruppenprozesse und des Delphi-Verfahrens

Der nominale Gruppenprozess zur Aktualisierung der Leitlinie fand am 24. und 25. August 2010 unter der Leitung von Herrn Priv.-Doz. Dr. med. H. Sitter (Institut für Chirurgische Forschung, Marburg) unter Beteiligung verschiedener Fachvertreter in Mannheim statt. Die Teilnehmer waren im Einzelnen: Frau Prof. Dr. med. S. Kösling (Vertreterin der Arbeitsgemeinschaft Kopf-Hals-Diagnostik der Deutschen Röntgengesellschaft), Herr Dr. med. G. Gronke (Leiter Ressort Leitlinien des Deutschen Berufsverbandes der Hals-Nasen-Ohren-Ärzte e. V.), Prof. Dr. med. C. Bachert (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Teilnahme nur am 25.08.2010), Prof. Dr. med. P. Federspil (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde), Prof. Dr. med. W. Hosemann (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde), Prof. Dr. med. K. Hörmann (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde), Prof. Dr. med. L. Klimek (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Teilnahme nur am 25.08.2010), Prof. Dr. med. Dipl. Ing. R. Mösges (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde), Priv.-Doz. Dr. med. O. Pfaar (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde), Prof. Dr. med. B.A. Stuck (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde) und Prof. Dr. med. R. Weber (Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Teilnahme nur am 24.08.2010).

Die Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM) hat ebenfalls an der Überarbeitung mitgewirkt und Herr Prof. Dr. med. A. Podbielski als Vertreter benannt. Dieser hat umfangreiche Kommentare zur Leitlinie erstellt, jedoch nicht am nominalen Gruppenprozess teilgenommen. Die DGHM hat Prof. Dr. med. B.A. Stuck autorisiert, die Kommentare im Rahmen des nominalen Gruppenprozesses einzubringen.

Des Weiteren wurde die Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DGAM) aufgefordert, an der Aktualisierung der Leitlinie mitzuwirken. Dies wurde jedoch von Seiten der DGAM abgelehnt. Ferner wurde die Bundesarbeitsgemeinschaft Selbsthilfe mehrfach schriftlich wie fernmündlich gebeten, an der Leitlinie mitzuwirken. Die Anfragen wurden jedoch nicht beantwortet.

Die Teilnehmer am nominalen Gruppenprozess erhielten am 06.07.2010 eine Tischvorlage der Leitlinie. Auf der Basis dieser Tischvorlage wurde die Leitlinie entsprechend der formalen Vorgaben für nominale Gruppenprozesse diskutiert und in strittigen Fragen per Abstimmung ein Konsens erzielt. Im Rahmen der Abstimmung genügte die einfache Mehrheit.

Die im Rahmen des nominalen Gruppenprozesses überarbeitete Fassung wurde dann in einem Delphi-Verfahren abschließend konsertiert. Am Delphi-Verfahren nahmen die Autoren der Leitlinie und die Fachvertreter der Deutschen Röntgengesellschaft, der Deutschen Gesellschaft für Hygiene und Mikrobiologie und des Berufsverbandes für Hals-Nasen-Ohren-Ärzte teil.

Der zur Erstellung der Empfehlungen der Leitlinie notwendige Konsensprozess wurde durch die Kombination zweier formalisierter Konsensverfahren erzielt. Die hierzu eingesetzten Verfahren sind der nominale Gruppenprozess und die Delphi-Technik. Beim nominalen Gruppenprozess treffen sich die Beteiligten unter Leitung eines neutralen Moderators zu streng strukturierten Sitzungen, deren Ablauf in folgende Schritte gegliedert ist:

  1. 1.

    Präsentation der zu konsentierenden Aussagen.

  2. 2.

    Jeder Teilnehmer verfasst Änderungsvorschläge und Anmerkungen zu den vorgeschlagenen Aussagen und Algorithmen.

  3. 3.

    Diese Kommentare werden der Reihe nach von einem unabhängigen und nicht stimmberechtigten Moderator abgefragt und gesammelt. Ähnliche Kommentare werden zusammengefasst.

  4. 4.

    Über jeden Vorschlag wird abgestimmt, ob darüber diskutiert werden soll.

  5. 5.

    Daraus ergibt sich eine Rangfolge der Vorschläge für die Diskussion.

  6. 6.

    Nun findet die Diskussion gemäß der Rangfolge statt.

  7. 7.

    Die Mehrheitsentscheidung zu jedem Punkt wird protokolliert und die Leitlinie wird gemäß dieser Beschlüsse bis zum nächsten Treffen überarbeitet.

  8. 8.

    Beim nächsten Treffen durchläuft man wieder die obigen Schritte 1 bis 6 für die überarbeitete Version.

Dieses Verfahren wird bis zur Erzielung eines Konsenses fortgesetzt. Für Fragen, die bei der obigen Priorisierung eine untergeordnete Rolle spielten, wurde die Delphi-Technik benutzt. Bei einem Delphi-Prozess verläuft die Konsensfindung analog zu den oben beschriebenen Schritten, jedoch treffen sich die Teilnehmer nicht, sondern kommunizieren nur auf schriftlichem Wege.

Für die Leitlinie wurde abschließend eine Kurzfassung erstellt, die sich vornehmlich aus grundsätzlichen methodischen und nosologischen Ausführungen sowie den Empfehlungen zur Diagnostik und Therapie zusammensetzt. Diese Kurzfassung wurde ebenfalls im Rahmen des Delphi-Prozesses abgestimmt.

Finanzierung und Interessenkonflikte

Die Leitlinie wurde ohne externe Finanzierung und ausschließlich mit den Finanzmitteln der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie entwickelt. Alle Autoren haben ihre Interessenkonflikte offengelegt, dabei waren auch alle Beziehungen zu Einrichtungen der pharmazeutischen Industrie und zu Medizinprodukteherstellern anzugeben. Die Angaben wurden durch das Koordinatorenteam bewertet, dabei wurden keine Interessenkonflikte festgestellt, die die fachliche Unabhängigkeit der Autoren im Hinblick auf die Erstellung der Leitlinie beeinträchtigen könnten.

Gültigkeitsdauer und Aktualisierung

Diese Leitlinie ist gültig bis 01.03.2014, spätestens zu diesem Zeitpunkt erfolgt eine inhaltliche Überprüfung und ggf. eine Aktualisierung. Werden dem Leitlinienkoordinator zwischenzeitlich Erkenntnisse bekannt, die eine Überarbeitung der Leitlinie erfordern, so erfolgt die Aktualisierung bereits früher.

Verabschiedung der Leitlinie

Die vorliegende Fassung der Leitlinie wurde im April 2011vom Präsidium der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie beraten und angenommen.

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Stuck, B., Bachert, C., Federspil, P. et al. Leitlinie „Rhinosinusitis“ – Langfassung. HNO 60, 141–162 (2012). https://doi.org/10.1007/s00106-011-2396-7

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