Update epos 2020 (the european position paper on rhinosinusitis and nasal polyps)

UPDATE
EPOS 2020
(THE EUROPEAN
POSITION PAPER ON
RHINOSINUSITIS AND
NASAL POLYPS)

MD. HUNG SON TA


DEFINITION


ACUTE RHINOSINUSITIS

 No changes have been made compared to EPOS2012 in the definition of

severity or in acute versus chronic(3). For acute rhinosinusitis the term
ARS comprises viral ARS (common cold) and post-viral ARS.








MANAGEMENT OF
ARS


viral ARS (common cold); postviral ARS and ABRS (acute
bacterial rhinosinusitis) .



ABRS: 0.5-2%



Bacterial infection may occur in
ARS, but in most cases antibiotics
have little effect on the course of
the illness



The EPOS2020 steering group
decided to maintain suggestions
made in the earlier EPOS versions:
at least three of five symptoms of
discoloured discharge, severe
local pain, fever, elevated
ESR/CRP and double sickening.


CHRONIC
RHINOSINUSITIS


CHRONIC

RHINOSINUSITIS



DIAGNOSTIC TOOLS – CT SCANNER
 CT scanner: Lund-Mackay system, the degree of opacification for the maxillary, anterior

and posterior ethmoids, frontal and sphenoid sinuses (0-none; 1-partial; 2-complete) and
OMC (0 or 2) giving a maximum score of 24 or 12/side.
 good correlation between CT and endoscopy but generally not between symptoms and CT
 >40% of patients who fulfil the symptom based diagnosis of CRS may have normal CT and

endoscopy results
LMS >2: Sensitivity 94%, specificity 41%
LMS >4: specificity 59 %
LMS >5, pediatric rhinosinositis: Sensitivity 86%, specificity 85%
→
LMS ≤ 2: an excellent negative predictive value
LMS ≥ 5: an excellent positive predictive value
 It was acceptable to use a previously performed CT scan of the sinuses which has been
done up to six months earlier
 preoperative CT is mandatory for sinus surgery in most countries and should be available
in the operating theatre


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS

MEDICAL MANAGEMENT


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT

 It is uncertain whether or not the use of a short course of antibiotics has an

impact on patient
outcomes in adults with CRS compared with placebo


MANAGEMENT OF CHRONIC
RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
LONG-TERM ANTIBIOTICS


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
LONG-TERM ANTIBIOTICS


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
LONG-TERM ANTIBIOTICS

The EPOS2020 steering group, due to the low quality of
the evidence, is uncertain whether or not the use of longterm antibiotics has an impact on patient outcomes in
adults with CRS, particularly in the light of potentially

increased risks of cardiovascular events. There is a need for
MANAGEMENT
RHINOSINUSITIS
IN ADULTS
the
largerOF CHRONIC
high-quality
trials
that are presently being
MEDICAL MANAGEMENT
undertaken
in
Europe.
LONG-TERM ANTIBIOTICS


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN
ADULTS
MEDICAL MANAGEMENT
TOPICAL ANTIBIOTICS


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
TOPICAL ANTIBIOTICS

 Topical antibacterial therapy does not seem to be more

effective than placebo in improving symptoms in patients
with CRS. However, it may give a clinically non-relevant

improvement in symptoms, SNOT-22 and LK endoscopic
score compared to oral antibiotics.


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
NASAL CORTICOSTEROIDS


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
NASAL CORTICOSTEROIDS
 42 study: 40 studies were placebo-controlled trials assessing the effects of nasal

corticosteroids .


MANAGEMENT OF CHRONIC RHINOSINUSITIS IN ADULTS
MEDICAL MANAGEMENT
NASAL CORTICOSTEROIDS
 Nasal corticostereoids have a positive impact on disease specific and general QOL in

patients with CRS.
 Long term treatment with nasal corticosteroids is effective and safe in patients with CRS.
 During pregnancy it is advised to continue nasal corticosteroid sprays for CRS maintenance.