When to operate on a patient without chronic disease?
Reviewed by Joanna Stephens

As ENT surgeons, we spend a lot of time managing chronic rhinosinusitis, so a review and update on the management of the acute disease is always helpful. The standard medical treatment of antibiotics, nasal steroids and nasal decongestants are reported by a number of papers as effective, as expected. There is also good evidence from multiple papers for the use of balloon sinuplasty and for endoscopic sinus surgery (ESS), with a reduction in SNOT scores and also in number of days missed from work. Generally, the trend was that surgically treated patients had better outcomes than medically treated patients, which is very interesting. Some really useful information is that the consensus reached by a panel of nine experts was that ESS is indicated in patients who suffer four or more episodes of recurrent acute sinusitis after a failure of medical treatment, and where at least one episode was confirmed by either CT or nasendoscopy. It is important that there is good objective evidence of active disease before embarking on surgery and reaching a shared decision with the patient. The authors conclude that more research would be useful, but this is helpful in guiding when to adopt surgical management of recurrent acute episodes.

Management of Recurrent Acute Rhinosinusitis: A Systematic Review.
Saltagi M, Comer BT, Hughes S, et al.
AM J RHINOL ALLERGY
2021;35(6):902-9.