European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, 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. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Pilonidal sinus of external auditory canal as unpredicted lesion: rarest case presentation and review of literatures

Abstract Background Pilonidal sinus (PNS) is considered as a benign lesion of hair-bearing areas, particularly at the sacrococcygeal area. It is presented as a hole or tunnel in the skin. It may be filled with fluid or pus resulting in the formation of a cyst or abscess. Although PNS is a well-established lesion in general surgery as well as dermatology specialties by its occurrence at the sacrococcygeal region, but the surprising presentation of PNS is that at ENT specialty by its appearance at the external auditory canal (EAC), which is deemed unpredicted lesion at this particular region. Case presentation Nine years female Libyan child has been presented with a history of persistent offensive bloody stained yellowish discolored left ear otorrhea a few months before her presentation. The local examination including the microscopic examination revealed evidences of a grayish-pinkish pedunculated polypoidal mass raised from the junction of the superior wall with the anterior wall of the EAC, at the site of the junction between the cartilaginous and bony portions of EAC. The temporal bone CT scan revealed evidences of radiolucent soft tissue density mass arising from the wall of the EAC at its anterior-superior junction, with the intact tympanic membrane as well as the middle ear cavity. This was most probably in favor of the suggestion of granulation tissue or aural polyp. The mass was completely excised as one piece from its pedicle and sent for histopathological evaluation, which was in favor of the diagnosis of PNS. Conclusion We consider this case for reporting because of its scarcity and unexpected lesion at EAC. To the best of our knowledge, our case constitutes the second case of the EAC specifically, and the third case of external ear generally reported in the world. Thus, we tried to illustrate this unique and rare EAC lesion concerning how it is clinically as well as pathologically presented. In addition, we tried to review the literatures to elucidate whether this rare lesion has been reported before