Current Philosophy in the Surgery for Chronic Rhinosinusitis

Purpose of Review: Despite the paucity of level I evidence from meta-analysis of randomized, controlled trials, physicians have to make decisions regarding the surgical management of chronic rhinosinusitis (CRS). In this review we attempt to summarize the current state of knowledge regarding surgery for CRS. Recent Findings: A well known, often repeated adage is that the extent of surgery must be tailored to the extent of disease. At the same time, there is an increasing body of evidence that more extended procedures are associated with better overall outcomes. Adverse predictive factors include the presence of acetylsalicylic acid (ASA) intolerance, cystic fibrosis (CF), biofilms, osteitis, and immunodeficiency. Overall, about 10–20% of patients submitted to sinus surgery with simultaneous medical therapy will not avoid a revision procedure. The use of balloon catheters as a valid alternative to standard ESS techniques is not supported by current evidence. Summary: Advantages of endoscopic sinus surgery include safety and the capacity to improve both symptom scores (especially nasal obstruction) and objective measures. Improvement in distribution of topical therapy is a major method of action.