Chronic Sinusitis Guidelines

Updated: Jan 19, 2022
  • Author: Itzhak Brook, MD, MSc; Chief Editor: John L Brusch, MD, FACP  more...
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Guidelines

Guidelines Summary

Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis. [80]

Consensus statements statement: biologic therapies for CRS with polyps.

  1. Patients must have both subjective and objective findings consistent with the diagnosis of CRSwNP to qualify for biologic therapy. All endotypes of CRSwNP are considered eligible except for primary ciliary dyskinesia and cystic fibrosis.
  2. Patients with CRSwNP do not need another Type 2 inflammatory condition such as asthma to be considered for biologic therapy
  3. There is insufficient evidence to make a recommendation for providing biologics to patients with CRSsNP.
  4. Biologics should not be provided to those suffering with recurrent acute bacterial sinusitis.
  5. The severity of subjective CRS symptoms needs to be moderate to severe based on the clinicians choosing of a validated patient reported outcome measure for chronic sinus disease.
  6. Biologics should only be considered for those who have undergone adequate sinus surgery and failed appropriate medical therapy following surgery. Patients unfit for surgery who have failed AMT may also be considered candidates for biologic therapy.
  7. Option: A CT sinus scan performed prior to administration of biologics may determine if adequate sinus surgery was performed and to objectively confirm global mucosal inflammation.
  8. Response to biologics is based on subjective and objective improvement. Patients should experience an improvement to some or all of their major symptoms which include sense of smell, nasal obstruction, nasal discharge and facial pain. By 16 weeks, there should also be objective improvement on endoscopy or CT scan and this should be re-evaluated at 1 year.
  9. Providers have the option of providing another biologic therapy if patients fail to respond to one biologic agent but continue to fit the inclusion criteria for biologic therapy. At this time, there are no biological markers to determine the best biological agent to use.
  10. Cost of biologics matters in the decision making of the use of biologics for CRS patients.
  11. The short-term use of biologics (12 months) in CRSwNP is considered safe. In other Type 2 inflammatory conditions, biologics have been shown to be safe long term.