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

Dutch Translation and Cross-cultural Adaptation of the Lysholm Score and Tegner Activity Scale for Patients With Anterior Cruciate Ligament Injuries

Study Design Clinical measurement. Background The Lysholm score and Tegner Activity Scale are frequently used patient-reported instruments to determine the functional status and activity level after anterior cruciate ligament (ACL) reconstruction. Objectives To translate and cross-culturally adapt the Lysholm score and Tegner Activity Scale for use in the Dutch population and to evaluate reliability and validity of these questionnaires in individuals after ACL reconstruction. Methods The translation and adaptation was conducted in several steps according to the guidelines in the literature. The measurement properties of the Lysholm score and Tegner Activity Scale (internal consistency, construct validity, and floor and ceiling effects) were tested in 96 patients. Reproducibility was tested in 69 patients, for patient with anterior cruciate ligament injuries. On the first occasion, the International Knee Documentation Committee (IKDC) and RAND-36 item Health Survey (RAND-36) were also administered. Results The Lysholm score and Tegner Activity Scale showed good test-retest reliability between repeated measures (respectively ICC 0.93 and 0.97). Internal consistency was reasonable to good (Cronbach's α=0.70-0.83). The Lysholm score had a very strong correlation with the IKDC (r= 0.83, p&lt;0.01) and moderate correlation with the RAND-36 (r=0.55, p&lt;0.01). The Tegner Activity Scale had a moderate correlation with both IKDC and the RAND-36 (r= 0.42 p&lt;0.01 respectively r= 0.48 p&lt;0.01). Conclusion This study demonstrated acceptable psychometric performances for the Lysholm score and the Tegner scale as outcome measures for Dutch patients after ACL reconstruction. J Orthop Sports Phys Ther, Epub 28 Sep 2016. doi:10.2519/jospt.2016.6566.</p

Postoperative Management of Pediatric Sinusitis

Postoperative management is essential to maximizing the clinical outcomes following pediatric sinus surgery. This chapter examines the current approach to postoperative care following functional endoscopic sinus surgery in the pediatric population. Nasal saline irrigations are a mainstay for many surgeons with a high efficacy and tolerability in children. Additional therapies include saline sprays, topical antibiotics, and topical steroids. Systemic forms of steroids or antibiotics may be considered in the short-term recovery period to help with healing, particularly in moderate to severe disease. Additionally, chronic rhinosinusitis with nasal polyps showed increased response rates postoperatively to systemic steroids. Unlike in adult populations, postoperative debridement is unnecessary in most pediatric cases with no demonstrated improvement in surgical success rates in patients who do not get debridement compared to those who get a second look with debridement. Postoperative care and continuing medical management should be individualized to the patient’s comorbidities and underlying etiology of chronic sinusitis. Cystic fibrosis requires special consideration with saline irrigations, corticosteroids, and antibiotics, with consideration of dornase alfa and gene therapy. The chapter concludes that functional endoscopic sinus surgery has been an effective tool in treating pediatric sinusitis refractory to medical therapy, with postoperative care recognized as having utmost importance to bridge surgical therapy with continued medical treatment for pediatric chronic rhinosinusitis