International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Preliminary efficacy of fluticasone delivered by a novel device in recalcitrant chronic rhinosinusitis

Objective: To assess whether delivery of fluticasone propionate using a novel bi-directional delivery device (Opt-FP) offers therapeutic benefits in patients with chronic rhinosinusitis (CRS). Methods: A prospective, single centre, randomized, double-blind, placebo (PBO)-controlled, parallel group study was conducted in adult subjects (n = 20) with CRS without nasal polyps or only cobblestoned mucosa. Subjects received Opt-FP 400 jig or placebo twice daily jar 12 weeks (n = 10/group). Outcome measures included symptom scores, RSOM-31, CRS VAS, nasendoscopy, peak nasal inspiratory flow (PNIF) and magnetic resonance imaging (MRI). Results: Endoscopy score for oedema showed a highly significant and progressive improvement (12 weeks (median scores): Opt-FP -4.0, PBO -1.0, p = 0.015). PNIF increased significantly during Opt-FP treatment compared to placebo (4 weeks: p = 0.006; 8 weeks: p = 0.03). After 12 weeks MRI scores in the Opt-FP group improved against baseline (p = 0.039) and a non-significant trend was seen versus placebo. The nasal RSOM-31 subscale was significantly improved with Opt-FP treatment (4 weeks: p = 0.009, 8 weeks: p = 0.016, 12 weeks: NS). Sense of smell, nasal discomfort and combined score were all significantly improved (p <0.05). The Opt-FP was well tolerated. Conclusions: The OptiNose breath-actuated bi-directional delivery device administering fluticasone propionate (400 mu g b.i.d.) is an effective and well tolerated treatment for recalcitrant CR