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Background: Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence‐based management strategies for CRS in this population. Methods: Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full‐text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit‐harm assessments, as well as value judgment and recommendations, were provided Results: Strong evidence confirms the benefit of oral and topical medications on sinonasal‐specific outcomes in individuals with CRSwA; there is low‐grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal‐ and asthma‐specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal‐ and asthma‐specific outcomes. Conclusion: Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second‐line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status. [ABSTRACT FROM AUTHOR]

Objective: To determine the minimal clinically important difference (MCID) of the 22‐item Sinonasal Outcome Test (SNOT‐22) in individuals undergoing medical management for their chronic rhinosinusitis (CRS). Design: Prospective observational study. Setting: Academic, tertiary care centre. Participants: A total of 247 adults undergoing medical management for CRS. Main outcome measure: At enrolment, participants completed a SNOT‐22. At a subsequent follow‐up visit, 2‐12 months after enrolment, participants also completed a SNOT‐22. At follow‐up, participants also rated the change in their sinus symptoms and general health as “Much worse,” “A little worse,” “About the same,” “A little better” or “Much better” compared with enrolment; these two questions were used as sinus symptom and general health anchor questions, respectively. The SNOT‐22 MCID was calculated using distribution‐based, anchor‐based and receiver operating characteristic (ROC) curve‐based methods. Results: Using the distribution‐based method, the SNOT‐22 MCID was 11.6. Using the sinus symptom anchor question, the SNOT‐22 MCID was 10.5; applying the ROC method to the sinus symptom anchor yielded an MCID of 12.5. In comparison, using the general health anchor question, the SNOT‐22 MCID was 8.3; applying the ROC method to the sinus symptom anchor yielded an MCID of 17.5. In all cases, the calculated MCID had a sensitivity of approximately 50‐60% and specificity of approximately 80‐90%. Conclusions: Based on our results, we propose a SNOT‐22 MCID of 12 in medically managed patients with CRS. The MCID, while specific, was not sensitive for identifying patients with CRS experiencing a noticeable improvement in sinus symptoms or general health. [ABSTRACT FROM AUTHOR]

Background: Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post‐ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. Methods: This was a randomized, double‐blind, placebo‐controlled, noninferiority trial comparing amoxicillin‐clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow‐up, QOL was measured with 22‐item Sino‐Nasal Outcome Test questionnaires and Lund‐Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated‐measures analysis of variance and analysis of covariance and z tests for proportions. Results: Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT‐22 scores (β = 0.18, 2‐tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). Conclusion: Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal‐specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post‐ESS and significantly increases the rate of diarrhea. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient‐reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ‐5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR. Results: Significant demographic and comorbid differences between BITR and non‐BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease‐specific (SNOT‐22 and CSS) and general (EQ‐5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures. Conclusion: Patients undergoing ESS achieve similar long‐term improvement in both disease‐specific and general QOL regardless of the performance of concurrent BITR. [ABSTRACT FROM AUTHOR]