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Canadian clinical practice guidelines for acute and chronic rhinosinusitis

Martin Desrosiers1*, Gerald A Evans2, Paul K Keith3, Erin D Wright4, Alan Kaplan5, Jacques Bouchard6, Anthony Ciavarella7, Patrick W Doyle8, Amin R Javer9, Eric S Leith10, Atreyi Mukherji11, R Robert Schellenberg12, Peter Small13 and Ian J Witterick14

Author Affiliations

1 Division of Otolaryngology - Head and Neck Surgery Centre Hospitalier de l'Université de Montréal, Université de Montréal Hotel-Dieu de Montreal, and Department of Otolaryngology - Head and Neck Surgery and Allergy, Montreal General Hospital, McGill University, Montreal, QC, Canada

2 Division of Infectious Diseases, Department of Medicine, and Departments of Microbiology & Immunology and Pathology & Molecular Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada

3 Deparmtent of Medicine, Division of Allergy and Clinical Immunology, McMaster University Hamilton, ON, Canada

4 Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada

5 Family Physician Airways Group of Canada and Brampton Civic Hospital, Richmond Hill, ON, Canada

6 Clinical Medicine, Laval's University Quebec and Department of Medicine, Hôpital de la Malbaie La Malbaie, QC, Canada

7 Family Physician Airways Group of Canada, Aldergrove, BC, Canada

8 Division of Medical Microbiology and Infection Control, Vancouver General Hospital and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

9 St Paul's Sinus Center and Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada

10 Department of Medicine, University of Toronto and Women's College Hospital, Halton Healthcare Services (Oakville Trafalger Site), Toronto, ON, Canada

11 Department of Medicine, Division of Infectious Diseases, McMaster University and Department of Medicine/Infectious Diseases, Hamilton General Hospital, McMaster Wing Hamilton, ON, Canada

12 Department of Medicine, Division of Allergy and Immunology, University of British Columbia, and James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital Vancouver, BC, Canada

13 Division of Allergy and Clinical Immunology, Jewish General Hospital and Department of Medicine, Department of Medicine, McGill University, Montreal, QC, Canada

14 Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada

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Allergy, Asthma & Clinical Immunology 2011, 7:2  doi:10.1186/1710-1492-7-2

Published: 10 February 2011

Abstract

This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment.

Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused.

Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document.

These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.