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EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists
Abstract
The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the…
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“Approximately 2% of viral rhinitis episodes are secondarily infected by bacterial organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with subsequent presentation of acute bacterial infection.138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“The development of acute, moderate to severe symptoms, and nasal purulence may be consistent with ARS or RARS rather than AR.1,137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“Nasal discharge is often purulent and may be discolored, with a tendency to be unilateral although may be bilateral.1,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“Some improvement in NO has been described in patients with NAR or rhinosinusitis, but the evidence is very weak”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [130]
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“Intranasal corticosteroids (INCs) (beclomethasone, budesonide, ciclesonide, fluticasone propionate, fluticasone furoate, mometasone, triamcinolone) have a potent antiinflammatory effect and have proven to be effective in treating NO in both rhinitis and rhinosinusitis, as shown in several international consensus statements [127-131].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [130]
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“In CRS with NP , endoscopic surgical treatment has been shown to be beneficial in patients with severe symptoms who do not respond to appropriate medical treatment [20,127,128,212-218] and may be more cost-effective [219,220].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [20]
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“Symptomatically, these conditions are characterized by nasal obstruction, nasal congestion, facial pressure or pain, anterior or posterior nasal discharge, and anosmia/hyposmia for varying durations of time.1,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“International consensus statements [127,130] recommend the use of INCs for both ARS and CRS with NP or CRS without NP.”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [130]
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“Conversely, AR is typically not associated with purulent or unilateral nasal discharge.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“A longer duration of illness suggests bacterial ARS.137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“In the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) statement, fever and elevated serum markers of inflammation (C-reactive protein or erythrocyte sedimentation rate) are also included as diagnostic criteria.138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“In general, viral ARS is present for less than 10 days.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“Progressive worsening over a short period of time (ie, 5 days) is also suggestive of bacterial ARS.137,138”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [138]
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“nasal obstruction has a prevalence close to the 30% in Europe”
From Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review (2024) · cites this paper as [28]
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“In some patients, there is increasing evidence of the involvement of a neurogenic signaling mechanism that causes the sensation of NO in the absence of real obstruction of the nasal passages [20].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [20]
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“Efficacy has not been demonstrated in patients with CRS and NP [130].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [130]
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Metadata
- Authors
- Fokkens, W. J., Lund, V. J., Mullol, J., Bachert, C., Alobid, I., Baroody, F., Cohen, N., Cervin, A., Douglas, R., Gevaert, P., Georgalas, C., Goossens, H., Harvey, R., Hellings, P., Hopkins, C., Jones, N., Joos, G., Kalogjera, L., Kern, B., Kowalski, M., Price, D., Riechelmann, H., Schlosser, R., Senior, B., Thomas, M., Toskala, E., Voegels, R., Wang, D. Y., & Wormald, P. J.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Royal National Throat Nose and Ear Hospital (GB)
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
- Ghent University (BE)
- University of Chicago (US)
- University of Pennsylvania (US)
- Lund University (SE)
- Auckland City Hospital (NZ)
- University of Amsterdam (NL)
- University of Antwerp (BE)
- UNSW Sydney (AU)
- KU Leuven (BE)
- Guy's Hospital (GB)
- University of Nottingham (GB)
- University of Zagreb (HR)
- Northwestern University (US)
- Medical University of Lodz (PL)
- University of Aberdeen (GB)
- Innsbruck Medical University (AT)
- Medical University of South Carolina (US)
- University of Southampton (GB)
- Universidade de São Paulo (BR)
- National University of Singapore (SG)
- Flinders University (AU)
- ORCID
- Venue
- Rhinology journal
- Publisher
- Stichting Nase
- Published
- 2012-03-01
- Volume
- 50
- Issue
- 1
- Pages
- 1-12
- ISSN
- 0300-0729 (ISSN-L)
- OpenAlex
- W1885435857
- Cited by
- 2,387
- References
- 51
- Citations by year
- 2026: 39 · 2025: 83 · 2024: 104 · 2023: 100 · 2022: 140 · 2021: 166 · 2020: 243 · 2019: 248 · 2018: 215 · 2017: 189 · 2016: 185 · 2015: 193 · 2014: 156 · 2013: 121 · 2012: 79
- FWCI
- 171.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Rhinology Journal (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Keywords
- sinusitis, nasal polyps, chronic rhinosinusitis without nasal polyps, chronic rhinosinusitis with nasal polyps, acute sinusitis, cystic fibrosis, aspirin-exacerbated respiratory disease, immunodeficiency, allergic fungal rhinosinusitis, inflammatory mechanisms, disease management
- MeSH terms
- Adult, Child, Chronic Disease, Humans, Nasal Polyps, Rhinitis, Sinusitis, Practice Guidelines as Topic
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