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

Clival Defect Resulting in Spontaneous Cerebrospinal Fluid Rhinorrhea: Case Report and Review of Literature

Spontaneous cerebrospinal fluid (CSF) rhinorrhea develops in patients without any history of trauma. Multiple factors have been theoretically debated. Also, localizing the defect may result in a challenge for the rhinologist. The common locations are the cribriform plate and the lateral recess of the sphenoid. Clival CSF rhinorrhea is rare, and only few cases have been reported so far. A 52-year-old female presented to the otolaryngology clinic with 7 years of history of left-side clear fluid rhinorrhea as a drop, which progressed to be runnier after she had pneumonia with severe cough secondary to COVID-19 infection. CSF was confirmed by a beta-2-transferrin test. During the perioperative evaluation, she developed meningitis which was treated with IV ceftriaxone and IV vancomycin antibiotics. The magnetic resonance imaging (MRI) and computerized tomography (CT) scan showed clival defect with pseudomeningocele which was initially not easy to see on CT. The patient underwent an endoscopic approach to the skull base to repair the defect with a pedicled septal flap. Also, a lumbar drain with intrathecal fluorescein administration was utilized. The postoperative course was uneventful without any complications. There was no evidence of recurrence with a 9-month follow-up postoperatively

Cleft Lip: A Comprehensive Review

Inauguration article/Review, I didn't put in an abstract because I noted similar articles in the journal didn't have an abstract. if one is needed then will do that