Kaszuba Scott M, Stewart Michael G
Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas, USA.
Am J Rhinol. 2006 Mar-Apr;20(2):186-90.
This study was performed to identify current patterns of diagnostic criteria and medical treatment for chronic rhinosinusitis (CRS) by otolaryngologists in the United States.
A 15-item survey was mailed to a random sample of 200 members of the American Academy of Otolaryngology-Head and Neck Surgery; statistical analysis was performed.
The overall response rate was 40.0%. Of respondents, 73% defined CRS as lasting >12 weeks. Seventy-three percent also believed radiological imaging was necessary for definitive diagnosis, but only 30% believed nasal endoscopy was necessary. Regarding treatment, respondents reported use of oral antibiotics (94%) and nasal corticosteroids (94%) as part of maximum medical management; oral decongestants, oral mucoevacuants, and allergy testing were used only by about one-half of the respondents, and less frequently topical decongestants (38%), oral corticosteroids (36%), and oral antihistamines (27%) were used. Oral corticosteroids were more likely to be used by specialists that self-classified as rhinologists than by other otolaryngologists (p = 0.005), but rhinologists were less likely to use radiological imaging (p = 0.04) as a diagnostic criterion. Pediatric otolaryngologists used allergy testing in medical management more frequently than other otolaryngologists (p < 0.001). Overall, the basis for choice of maximal medical management was personal clinical experience (74%), rather than clinical research results or expert recommendations.
We had a fairly small sample of returned surveys; therefore, our findings may not be generalizable to the entire population of U.S. otolaryngologists. Nevertheless, in our survey, U.S. otolaryngologists agree on the use of oral antibiotics and nasal corticosteroids as part of maximal medical management for CRS but do not agree on other adjuvant therapies or on the use of endoscopy as a diagnostic criterion.
本研究旨在确定美国耳鼻喉科医生对慢性鼻-鼻窦炎（CRS）的诊断标准和药物治疗的当前模式。
向美国耳鼻咽喉-头颈外科学会的200名成员随机抽样邮寄一份包含15个项目的调查问卷；进行了统计分析。
总体回复率为40.0%。在受访者中，73%将CRS定义为持续超过12周。73%的受访者还认为放射影像学检查对于明确诊断是必要的，但只有30%的人认为鼻内镜检查是必要的。关于治疗，受访者报告称，作为最大程度药物治疗的一部分，使用口服抗生素（94%）和鼻用糖皮质激素（94%）；只有约一半的受访者使用口服减充血剂、口服黏液促排剂和过敏检测，而使用局部减充血剂（38%）、口服糖皮质激素（36%）和口服抗组胺药（27%）的频率更低。自我归类为鼻科医生的专科医生比其他耳鼻喉科医生更有可能使用口服糖皮质激素（p = 0.005），但鼻科医生作为诊断标准使用放射影像学检查的可能性较小（p = 0.04）。儿科耳鼻喉科医生在药物治疗中使用过敏检测的频率高于其他耳鼻喉科医生（p < 0.001）。总体而言，选择最大程度药物治疗的依据是个人临床经验（74%），而非临床研究结果或专家建议。
我们回收的调查问卷样本相当小；因此，我们的研究结果可能无法推广至美国全体耳鼻喉科医生。尽管如此，在我们的调查中，美国耳鼻喉科医生对于将口服抗生素和鼻用糖皮质激素作为CRS最大程度药物治疗的一部分达成了共识，但在其他辅助治疗或鼻内镜检查作为诊断标准的使用上未达成共识。
