July 2025

ENT

CLINICAL PRACTICE GUIDELINE: SURGICAL MANAGEMENT OF CHRONIC RHINOSINUSITIS

Chronic rhinosinusitis (CRS) often requires surgical intervention, notably endoscopic sinus surgery. To help head and neck surgeons optimize patient outcomes, a new specialty-specific clinical practice guideline has been established.

Developed using a comprehensive protocol from the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the guideline involved a diverse group of experts, including otolaryngologists, rhinologists, advanced practice providers and patient representatives. Their goal was to create a robust framework that prioritizes patient care and evidence-based practices.

Key Recommendations
  • Confirm a CRS diagnosis based on established clinical criteria before considering surgical options.
  • Evaluate patients' symptoms, disease characteristics, quality of life and previous treatments to determine eligibility for surgery.
  • Only prescribe antibacterial medications if significant purulent nasal discharge is present.
  • Use a flexible approach to medical therapy regimens, not a one-size-fits-all model.
  • Identify patients who are likely to benefit from surgery, particularly those with specific CRS subtypes, such as those with polyps or chronic infection.
  • During pre-surgery consultations, set realistic expectations for potential outcomes, chronicity and post-surgical management.
  • Get a thorough CT scan of the paranasal sinuses to help with surgical planning.
  • Don’t make decisions on the extent of surgery based solely on arbitrary imaging criteria.
  • Educate patients about post-surgical recovery, including pain management, activity restrictions and follow-up care.
  • For complex cases, surgeries should aim for complete exposure and removal of diseased tissues rather than limited interventions.
  • Follow up with patients to evaluate surgical outcomes, assessing symptom relief and overall quality of life within three to 12 months post-surgery.

​By implementing these guidelines, clinicians can enhance CRS care and ensure a patient-centered approach backed by the latest evidence.

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