Updated guideline aims to identify quality improvement opportunities in managing adult sinusitis

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline (CPG): Adult Sinusitis Update today in Otolaryngology–Head and Neck Surgery. The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult sinusitis and to provide explicit and actionable guidance that can be implemented across all clinical practices.

With sinusitis affecting about one in eight adults in the United States each year, this CPG update empowers both patients and their healthcare providers with evidence-based recommendations that can lead to better outcomes."

Spencer C. Payne, MD, Chair of the Guideline Update Group

"Key changes from the 2015 guideline include expanding 'watchful waiting' as the preferred initial approach for most bacterial sinus infections, since most people get better on their own. We've also provided clearer guidance on when antibiotics are truly needed, what the first-choice antibiotic should be, and new information about advanced treatments like biologics for chronic sinusitis with nasal polyps. Most importantly, we've emphasized that not all sinus symptoms require antibiotics, and there are effective symptomatic treatments like nasal saline rinses and steroid sprays that can provide relief. We encourage patients to have open conversations with their healthcare providers about these options to find the right treatment approach for their specific situation."

Sinusitis affects approximately 12% of adults in the United States resulting in over 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life ranging from $12 to 20 billion. One in five antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy. Despite the high prevalence and economic impact of sinusitis, considerable practice variations exist across and within the multiple disciplines involved in managing the condition.

This CPG update provides 14 research-based key action statements that address such areas as unnecessary antibiotic use, conservative-treatment first approaches, objective confirmation for chronic cases, and targeted therapy options based on specific patient characteristics.

In the development of this CPG update, the guideline update group considered new evidence from 14 guidelines, 194 systematic reviews, and 133 randomized controlled trials. The group, which was led by AAO-HNSF, included representatives from the fields of otolaryngology, infectious disease, family medicine, allergy and immunology, advanced practice nursing, a patient advocate, and staff. Before the guideline was published, it went through public and peer review for comments.