Cited by 2,387Sinusitis and nasal conditionsNasal Surgery and Airway StudiesCystic Fibrosis Research Advances

EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

Fokkens, W.J., Lund, V.J., Mullol, J., Bachert, C., Alobid, I., Baroody, F., Cohen, N., Cervin, A. +21 more·2012·Rhinology journal

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 bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with subsequent acute bacterial infection.

    “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]

    Section 2.2, “Clinical definition of rhinosinusitis in children” (page unavailable), says that a small percentage of patients with post-viral acute rhinosinusitis develop bacterial acute rhinosinusitis. It does not give a 2% rate for viral rhinitis episodes or name the three bacterial species; it also uses post-viral rhinosinusitis patients, rather than all viral rhinitis episodes, as the denominator. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Development of acute, moderate to severe symptoms and nasal purulence may be consistent with ARS or RARS rather than AR.

    “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]

    Sections 2.1 and 2.2 include nasal discharge and mucopurulent discharge in the clinical definition of rhinosinusitis, and section 2.2 discusses acute rhinosinusitis. The retrieved passages do not establish that moderate-to-severe symptoms or nasal purulence distinguish ARS or RARS from allergic rhinitis, and they do not address RARS specifically. (LLM, conf=0.83)

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  • Nasal discharge in ARS is often purulent and may be discolored, with a tendency to be unilateral although it may be bilateral.

    “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]

    Sections 2.1 and 2.2 (page not available in our copy) identify nasal discharge as a rhinosinusitis symptom and mucopurulent discharge as a possible endoscopic sign. They do not say that discharge in acute rhinosinusitis is often purulent, may be discolored, or tends to be unilateral rather than bilateral. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Some improvement in NO has been described in patients with nonallergic rhinitis or rhinosinusitis with H1 antihistamines, but the evidence is very weak.

    “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]

    The CRS treatment table (p. 5) lists no data for adding oral antihistamines in allergic patients, consistent with the claim that evidence is weak. It does not describe improved nasal obstruction or address antihistamine treatment in nonallergic rhinitis; the treatment table on p. 8 likewise concerns allergic patients. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Intranasal corticosteroids have a potent anti-inflammatory effect and have proven effective in treating NO in both rhinitis and rhinosinusitis.

    “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]

    The paediatric CRS introduction (p. 9) states that intranasal corticosteroids have proven efficacy in adult chronic rhinosinusitis and in childhood allergic rhinitis; the CRSwNP management section (p. 7) also reports improved symptoms. The paper identifies nasal obstruction as a rhinosinusitis symptom (clinical definition, p. 3), but the passages do not specifically establish relief of nasal obstruction (NO) in both conditions or describe the drugs’ anti-inflammatory effect as potent. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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3 of the 51 references couldn’t be matched to a known paper.

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  1. [1]1. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. European position paper on rhinosinusitis and nasal polyps. Rhinol Suppl. 2005(18):1-87.
  2. [11]11. Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012 Jan;67(1):91-8.
  3. [26]26. Kudoh S, Kimura H, Uetake T, et al. Clinical effect of low-dose, long-term macrolide antibiotic chemotherapy on diffuse panbronchiolitis. Jpn J Thorac Dis. 1984;22:254-54.

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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)
Venue
Rhinology journal
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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