Lin Jiahui, Kacker Ashutosh
Department of Otolaryngology-Head and Neck Surgery Weill Cornell Medicine New York New York U.S.A.
Department of Otolaryngology-Head and Neck Surgery Columbia University Medical Center New York New York U.S.A.
Laryngoscope Investig Otolaryngol. 2019 Jul 10;4(4):379-382. doi: 10.1002/lio2.294. eCollection 2019 Aug.
Management of patients with recurrent acute rhinosinusitis (RARS) is often challenging, and robust data in the literature is scant. The aim of this study is to better characterize the current treatment strategies for RARS used by otolaryngologists.
An online survey sent to all members of the American Rhinologic Society in a 1 month period evaluated demographics, practice characteristics, and management strategies for patients with RARS, subdivided into those with (RARSwD) and without (RARSsD) septal deviation. Eighty-eight practicing members responded, of whom 41% were fellowship-trained rhinologists.
For most cases of RARSsD, 61% of otolaryngologists would primarily use medical management. Most would wait until patients had experienced 4-5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (79%). The sinus surgery procedure of choice was limited sinus surgery (62%). For RARSwD, 52% primarily chose medical management. Most would wait until patients had experienced 4-5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (78%). Nearly all fellowship-trained rhinologists (97%) would perform limited sinus surgery with septoplasty for RARSwD, compared to only 70% of other otolaryngologists who would do so and 24% who would perform complete sinus surgery with septoplasty. While 89% of practitioners in private practice would wait to perform balloon sinuplasty until patients had experienced 4-5 episodes, only 68% of those in academia would wait this long and 23% would do so after only 1-3 episodes.
Treatment of patients with RARS is complex, and the differences in strategies employed between groups of otolaryngologists may reflect their training backgrounds and different patient populations.
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复发性急性鼻-鼻窦炎（RARS）患者的管理通常具有挑战性，且文献中的有力数据较少。本研究的目的是更好地描述耳鼻喉科医生目前用于RARS的治疗策略。
在1个月内向美国鼻科学会的所有成员发送了一项在线调查，评估了RARS患者的人口统计学、执业特征和管理策略，这些患者分为有鼻中隔偏曲（RARSwD）和无鼻中隔偏曲（RARSsD）的患者。88名执业成员做出了回应，其中41%是接受过 fellowship 培训的鼻科医生。
对于大多数RARSsD病例，61%的耳鼻喉科医生主要采用药物治疗。大多数医生会等到患者经历4 - 5次发作后才进行球囊鼻窦成形术（80%）或正式鼻窦手术（79%）。首选的鼻窦手术方式是局限性鼻窦手术（62%）。对于RARSwD，52%主要选择药物治疗。大多数医生会等到患者经历4 - 5次发作后才进行球囊鼻窦成形术（80%）或正式鼻窦手术（78%）。几乎所有接受过 fellowship 培训的鼻科医生（97%）会对RARSwD进行伴有鼻中隔成形术的局限性鼻窦手术，相比之下，只有70%的其他耳鼻喉科医生会这样做，24%的医生会进行伴有鼻中隔成形术的全鼻窦手术。虽然89%的私人执业医生会等到患者经历4 - 5次发作后才进行球囊鼻窦成形术，但只有68%的学术机构医生会等这么久，23%的医生在患者仅经历1 - 3次发作后就会进行。
RARS患者的治疗很复杂，耳鼻喉科医生群体之间采用的策略差异可能反映了他们的培训背景和不同的患者群体。
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