Skip to main content

Advertisement

SpringerLink
Log in

A survey on chronic rhinosinusitis: opinions from experts of 50 countries

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or “about 50 %”, of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20–35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20–40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rudmik L (2015) Chronic rhinosinusitis: an under-researched epidemic. J Otolaryngol Head Neck Surg 44(1):11. doi:10.1186/s40463-015-0064-8 (published online 2015 Mar 5)

  2. Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL (2011) Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 121(12):2672–2678. doi:10.1002/lary.21847

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM (2014) Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 124(9):2007–2012. doi:10.1002/lary.24630

    Article  PubMed  PubMed Central  Google Scholar 

  4. Collins JG, Blackwell DL, Tonthat L, et al. (1997) Prevalence of selected chronic conditions: United States, 1990–1992 summary health statistics for the US population: National Health Interview Survey, 1997 Prevalence of the chronic sinusitis diagnosis in Olmsted County, Minnesota The role of nasal endoscopy in outpatient management. Vital Health Stat 10. 130(194):1–89

  5. Pilan RR, Pinna FR, Bezerra TF et al (2012) Prevalence of chronic rhinosinusitis in Sao Paulo. Rhinology. 50(2):129–138. doi:10.4193/Rhino11.256

    CAS  PubMed  Google Scholar 

  6. Kato A (2015) Immunopathology of chronic rhinosinusitis. Allergol Int. 64(2):121–130. doi:10.1016/j.alit.2014.12.006 (Epub 2015 Feb 9)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Steele TO, Mace JC, Smith TL (2015) Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery? Int Forum Allergy Rhinol. doi:10.1002/alr.21543 (Epub ahead of print)

  8. Chester AC (2009) Symptom outcomes following endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg. 17(1):50–58. doi:10.1097/MOO.0b013e32831b9e2a

    Article  PubMed  Google Scholar 

  9. Alexiou A, Sourtzi P, Dimakopoulou K, Manolis E, Velonakis E (2011) Nasal polyps: heredity, allergies, and environmental and occupational exposure. J Otolaryngol Head Neck Surg. 40:58–63

    PubMed  Google Scholar 

  10. Cohen NA, Widelitz JS, Chiu AG, Palmer JN, Kennedy DW (2006) Familial aggregation of sinonasal polyps correlates with severity of disease. J Otolaryngol Head Neck Surg. 134:601–604

    Article  Google Scholar 

  11. Rugina M, Serrano E, Klossek JM et al (2002) Epidemiological and clinical aspects of nasal polyposis in France; the ORLI group experience. Rhinology 40:75–79

    CAS  PubMed  Google Scholar 

  12. Lima JT, Paula FE, Proença-Modena JL et al (2015) The seasonality of respiratory viruses in patients with chronic rhinosinusitis. Am J Rhinol Allergy. 29(1):19–22

    Article  PubMed  Google Scholar 

  13. Weather. http://english.visitkorea.or.kr/enu/AK/AK_EN_1_1_2.jsp. Accessed 23 Nov 2015

  14. Climate and weather. http://www.studyincroatia.hr/about-croatia/climate-and-weather. Accessed 23 Nov 2015

  15. Climate of Malta. Wikipedia. https://en.wikipedia.org/wiki/Climate_of_Malta. Accessed 23 Nov 2015

  16. Climate of South Africa. Wikipedia. https://en.wikipedia.org/wiki/Climate_of_South_Africa. Accessed 23 Nov 2015

  17. McNally PA, White MV, Kaliner MA (1997) Sinusitis in an allergist’s office: analysis of 200 consecutive cases. Allergy Asthma Proc 18:169–175

    Article  CAS  PubMed  Google Scholar 

  18. Lobid I, Benítez P, Cardelús S et al (2014) Oral plus nasal corticosteroids improve smell, nasal congestion, and inflammation in sino-nasal polyposis. Laryngoscope 124(1):50–56

    Article  Google Scholar 

  19. Mucha SM, Baroody FM (2003) Sinusitis update. Curr Opin Allergy Clin Immunol 3(1):33–38

    Article  PubMed  Google Scholar 

  20. Suh JD, Kennedy DW (2011) Treatment options for chronic rhinosinusitis. Proc Am Thorac Soc. 8(1):132–140. doi:10.1513/pats.201003-028RN

    Article  CAS  PubMed  Google Scholar 

  21. Vining EM (2006) Evolution of medical management of chronic rhinosinusitis. Ann Otol Rhinol Laryngol Suppl 196:54–60

    PubMed  Google Scholar 

  22. Meltzer EO, Hamilos DL (2011) Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc 86:427–443

    Article  PubMed  PubMed Central  Google Scholar 

  23. Van Zele T, Gevaert P, Holtappels G et al (2010) Oral steroids and doxycycline in nasal polyps: two different approaches to treat nasal polyps. J Allergy Clin Immunol 125:1069–1076

    Article  PubMed  Google Scholar 

  24. Rosenfeld RM (2007) Clinical practice guideline on adult sinusitis. Otolaryngol Head Neck Surg 137(3):365–377

    Article  PubMed  Google Scholar 

  25. Slavin RG, Spector SL, Bernstein IL et al (2005) The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 116(6 Suppl):S13–S47

    Article  PubMed  Google Scholar 

  26. Chow AW, Benninger MS, Brook I et al (2012) IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 54(8):e72–e112

    Article  PubMed  Google Scholar 

  27. Lim M, Citardi MJ, Leong JL (2008) Topical antimicrobials in the management of chronic rhinosinusitis: a systematic review. Am J Rhinol 22(4):381–389

    Article  PubMed  Google Scholar 

  28. Ponikau JU, Sherris DA, Weaver A, Kita H (2005) Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, doubleblind pilot trial. J Allergy Clin Immunol 115:125–131

    Article  CAS  PubMed  Google Scholar 

  29. Stewart RA, Ram B, Hamilton G, Weiner J, Kane KJ (2008) Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis. Otolaryngol Head Neck Surg 139(5):682–687

    Article  PubMed  Google Scholar 

  30. Parnes SM, Chuma AV (2000) Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. ENT J 79(1):18–20

    CAS  Google Scholar 

  31. Harvey R, Hannan SA, Badia L, Scadding G (2007) Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochr Database Syst Rev 18(3):CD006394

  32. Settipane GA (1996) Epidemiology of nasal polyps. Allergy Asthma Proc 17:231–236

    Article  CAS  PubMed  Google Scholar 

  33. Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23(3):1–298

    Google Scholar 

  34. Chester AC, Antisdel JL, Sindwani R (2009) Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg 140(5):633–639

    Article  PubMed  Google Scholar 

  35. Bachert C, Pawankar R, Zhang L, et al. (2014) ICON: chronic rhinosinusitis. World Allergy Organ J. 27;7(1):25. doi:10.1186/1939-4551-7-25 (eCollection 2014)

  36. Hamilos DL (2011) Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol 128(4):693–707

    Article  PubMed  Google Scholar 

  37. Dalziel K, Stein K, Round A, Garside R, Royle P (2006) Endoscopic sinus surgery for the excision of nasal polyps: a systematic review of safety and effectiveness. Am J Rhinol. 20(5):506–519

    Article  PubMed  Google Scholar 

  38. Rimmer J, Fokkens W, Chong LY, Hopkins C (2014) Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev. 12:CD006991. doi:10.1002/14651858.CD006991.pub2 (Epub 2014 Dec 1)

Download references

Acknowledgments

No pharmaceutical companies funded the study or contributed to the study design, outcome evaluation, or writing of this article.

Author information

Authors and Affiliations

  1. Department for ORL Head and Neck Surgery, University of Siena, Siena, Italy

    Desiderio Passali, Jacopo Cambi & Maria Luisa Bellussi

  2. Department for ORL Head and Neck Surgery, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

  3. ENT Clinics, University of Roma Tor Vergata, Rome, Italy

    Francesco Passali

  4. Department for ORL Head and Neck Surgery, Faculty of Medicine, Kırıkkale University, Kirikkale, Turkey

    Nuray Bayar Muluk

  5. Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Blok, No: 6-3/43, 06610, Çankaya/Ankara, Turkey

    Nuray Bayar Muluk

Authors
  1. Desiderio Passali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cemal Cingi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacopo Cambi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Passali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nuray Bayar Muluk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Luisa Bellussi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nuray Bayar Muluk.

Ethics declarations

Conflicts of interest

The authors declare that there is no conflicts of interest.

Appendix 1: Rhinosinusitis survey

Appendix 1: Rhinosinusitis survey

  1. 1.

    Which is the percentage of patients suffering from chronic rhinosinusitis (CRS) in your Country?

    • 15 %

    • 25 %

    • 50 %

    • 70 %

  2. 2.

    What time of the year the nasal symptoms are more intense?

    • Spring

    • Summer

    • Autumn

    • Winter

    • Always

  3. 3.

    Among the following, which are the most common symptoms reported by patients diagnosed for CRS?

    • Anterior rhinorrhea

    • Postnasal drip

    • Headache

    • Facial pain

    • Hyposmia

    • Cacosmia

    • Nasal obstruction

    • Lacrimation

    • Photophobia

    • Cough

    • Fever

  4. 4.

    Which objective investigation do you perform in the assessment of a patient with probable CRS?

    • Anterior rhinoscopy

    • Nasal mucosa cytology, biopsy and bacteriology

    • Sinus transillumination

    • Fiberoptic endoscopy

    • CT of the nose and paranasal sinuses

  5. 5.

    Which are the most frequently involved sinuses (CT evaluation)?

    • Maxillary

    • Ethmoid

    • Sphenoid

    • Front

    • All

  6. 6.

    In case of CRS, which is the medical treatment of your choice?

    • Nasal wash

    • Nasal decongestant drugs

    • NSAIDs systemically

    • Systemic corticosteroids

    • Nasal corticosteroids

    • Local antibiotics

    • Systemic antibiotics

  7. 7.

    How long do you prescribe intranasal therapy before a new control visit?

    • 1 month

    • 2 month

    • 3 month

    • More than 3 months

  8. 8.

    How many of your patients report subjective improvement of symptoms after treatment?

    • About 20 %

    • About 35 %

    • About 50 %

    • More than 50 %

  9. 9.

    How many of your CRS patients require surgery?

    • 20 %

    • 35 %

    • 50 %

    • More than 50 %

  10. 10.

    Which is the medical treatment of your choice in the post-surgery follow-up of a patient with CRS?

    • Nasal wash

    • Nasal decongestant drugs

    • NSAIDs systemically

    • Systemic corticosteroids

    • Nasal corticosteroids

    • Local antibiotics

    • Systemic antibiotics

  11. 11.

    In how many of your patients CRS is associated with nasal polyps?

    • About 20 %

    • About 40 %

    • About 50 %

    • More than 50 %

  12. 12.

    Which is the medical treatment of your choice in a patient with nasal polyposis?

    • Nasal wash

    • Nasal decongestant drugs

    • NSAIDs systemically

    • Systemic corticosteroids

    • Nasal corticosteroids

    • Local antibiotics

    • Systemic antibiotics

  13. 13.

    Which is the administering device of your choice in the post-operative follow-up of a patient with CRS and NP?

    • Aerosol therapy

    • Nasal douche

    • Nasal Spray

    • Nasal drops

    • Other (specify)

  14. 14.

    Which is the medical treatment of your choice in the post-operative follow-up of a patient with CRS and NP?

    • Nasal wash

    • Nasal decongestant drugs

    • NSAIDs systemically

    • Systemic corticosteroids

    • Nasal corticosteroids

    • Local antibiotics

    • Systemic antibiotics

  15. 15.

    How often do you submit your patients to follow-up visits?

    • Every 3 months

    • Every 6 months

    • Every 12 months

    • Other (specify)

  16. 16.

    Which is the rate of recurrence in 3 years after surgery of your patients with nasal polyposis?

    • About 10 %

    • About 25 %

    • About 40 %

    • More than 40 %

  17. 17.

    Which is the medical treatment of your choice in a patient suffering for CRS and allergic rhinitis?

    • Traditional medical therapy

    • Homeopathic treatment

    • Herbal medicine

    • Other

  18. 18.

    When would you submit allergic patients to treatment?

    • During the period of acute

    • Before the period of acute

    • Before and during the period of acute

    • All year round

  19. 19.

    In your Country, which is the first practitioner to which a patient with CRS is addressed?

    • GP

    • Otorhinolaryngologist

    • Neurologist

    • Pulmonologist

    • Allergologist

    • Dentist

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Passali, D., Cingi, C., Cambi, J. et al. A survey on chronic rhinosinusitis: opinions from experts of 50 countries. Eur Arch Otorhinolaryngol 273, 2097–2109 (2016). https://doi.org/10.1007/s00405-015-3880-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-015-3880-6

Keywords

Search

Navigation