engleski

Evidence-based treatment of chronic rhinosinusitis

Although chronic rhinosinusitis is one of the most common chronic disorders and major advances in minimally invasive surgery and potent antimicrobial and anti-inflammatory conservative treatment have been acomplished in the past decade, the evidence for most effective treatment is still lacking. Randomized controlled trials (RCT), which provide the best possible evidence, in terms of testing the efficacy of CRS treatment are too few. Those that are done so far, have proven advantages of endoscopic sinus surgery over classical radical surgery in terms of providing better health related quality of life. Case controlled studies of endoscopic sinus surgery have shown a 91% (73-97, 5%) improvement with major complications rate of 1.6%. Still, at long term follow-up, improvement rate drops to 50% in revision cases and patients with systemic disease (allergy, asthma). Further improvement in surgical failures can be achieved with long-term topical steroid and low-dose macrolide treatment. Conservative treatment, which includes aggressive long-term steroid and antibiotic treatment, with permanent nasal saline douches and short term decongestants, have shown to be succesful in half of the treated patients, but follow-up is shorter. However, only few of clinical trials are RCT, and placebo-controlled studies have not recognized significant advantage of any conservative treatment. Level of evidence for treatment for pediatric sinusitis is satisfactory, and meta analysis of conservative treatment has been cited in the Cochrane Library Database. Meta analysis for pediatric sinusitis surgical treatment indicates success rate of 88% with an average follow-up of 3, 7 years and major complication rate of 0, 6%.

sinuitis - operacija; kronične bolesti; liječenje zasnovano na dokazu

nije evidentirano