European Position Paper on Rhinosinusitis and Nasal Polyps 2020.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

Computed tomography for the evaluation of children with chronic rhinosinusitis: proposal of a reduced examination and comparison with the standard examination.

Rhinosinusitis is a disease that has attracted increasing attention both in terms of triggering factors and of treatment evolution, with its possible complications and repercussions. Follow-up of chronic cases almost always requires imaging evaluation and computed tomography (CT) has been considered the 'gold standard' for these cases, for which the exam must often be repeated more than once. This fact implies submitting the patient to a greater radiation load and, in the case of some children, to repeated sedation, causing possible damage to the patient, concern to the parents and to the physician when he requests this procedure. In the present study, the authors propose a reduced CT technique compared to the standard exam, with a smaller number of slices, to be used for the initial evaluation of a case and for the follow-up of chronic cases, with the standard examination reserved for cases requiring the best possible anatomical detailing, such as surgical cases. The standard technique involves 2-mm thick sections spaced 5 mm apart. In the reduced technique, the spacing is 10 mm, with a consequent reduction in the number of sections. Twenty-one children aged 4-13 years were submitted for the examination. The advantages of the proposed method reside in the reduction of the radiation load to which the patient is exposed, in its better agility, with a reduced time of execution and a consequent increase in collaboration on the part of the child, and in the reduction on cost of the procedure. It is also a technique of easy execution that does not require specific technical training.