The management of chronic rhinosinusitis in primary care: an evidence-based guide.

Abstract

Presentations to general practice with the myriad of symptoms associated with chronic rhinosinusitis (CRS) are extremely common. The mainstay of management of this condition is carried out in primary care.1 This article covers the diagnosis and management of adult CRS in the light of evidence from the European position paper from 2012 on this condition.2 CRS is reported to affect 5–15% of the general population but only 2–4% of this is diagnosed by a doctor.3 Awareness of the relevant definitions will aid diagnosis and management of this common, but underdiagnosed, condition. Adult rhinosinusitis is defined as: ‘Inflammation of the nose and paranasal sinuses characterised by two or more of the following symptoms.’ 2 At least one of these must be: Other ‘non-essential’ symptoms that contribute to diagnosis include: Continuation of symptoms for >12 weeks differentiates chronic from acute rhinosinusitis.1 This definition can be refined with the aid of flexible nasendoscopy. This can help subdivide patients with CRS into two groups: those with and without nasal polyps.2 Patients with CRS may present to general practice with a wide array of symptoms.1 Along with those identified above there are a range of symptoms including:3,4 The use of symptom severity scales, such as the visual analogue scale …