New Guidelines for Surgical Treatment of Chronic Rhinosinusitis in Adults

On May 27, 2025, the American Academy of Otolaryngology-Head and Neck Surgery Foundation released updated clinical practice guidelines regarding the surgical treatment of chronic rhinosinusitis (CRS) in adults. This guideline aims to enhance the clinical decision-making process for healthcare providers treating patients with this common and often debilitating condition.

Developed by a team of experts led by a prominent physician from Harvard Medical School, the guidelines present 11 essential action statements intended to guide clinicians in determining the appropriateness of surgical interventions for patients diagnosed with chronic rhinosinusitis. One fundamental recommendation is the necessity for surgeons to confirm the diagnosis of chronic rhinosinusitis prior to considering any surgical options.

Importantly, the guidelines emphasize that there should not be a mandated duration or specific regimen of medical treatment before a patient is eligible for surgery. This flexibility allows surgeons to identify individuals who are likely to benefit from surgical intervention, particularly those with specific subtypes of CRS, such as CRS with nasal polyps, eosinophilic mucin, or associated fungal infections.

Furthermore, the guidelines advocate for clear communication regarding the expectations of surgery. Patients should be counseled about the potential for persistent symptoms or relapse following the procedure, as well as the necessity for ongoing medical management after surgery. This preoperative counseling is crucial in ensuring that patients have realistic anticipations regarding their recovery and long-term care.

For surgical planning, the guidelines recommend obtaining a high-resolution computed tomography (CT) scan of the paranasal sinuses. This imaging should follow a fine-cut protocol to provide detailed views that aid in surgical decision-making. The extent of surgery should not be determined based solely on arbitrary measures of mucosal thickening or sinus blockage observed on the CT scans.

Patients scheduled for sinus surgery should also be educated about what to expect in terms of postoperative care, including pain management strategies. Proper preparation can significantly influence a patient's recovery experience and overall satisfaction with the surgical outcome.

These guidelines serve as a vital resource for healthcare professionals, equipping them with evidence-based recommendations to improve patient care pathways for those requiring surgical treatment for chronic rhinosinusitis.