Riley Charles A, Zheng Zhong, Williams Nicholas, Smith Timothy L, Orlandi Richard R, Tabaee Abtin
Department of Otolaryngology-Head and Neck Surgery, Fort Belvoir Community Hospital and Walter Reed National Military Medical Center, Fort Belvoir, VA.
Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
Int Forum Allergy Rhinol. 2020 May;10(5):665-672. doi: 10.1002/alr.22533. Epub 2020 Feb 27.
The 2016 International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS) is a collaborative distillation of available research and consensus recommendations for the management for chronic rhinosinusitis (CRS). However, implementation of the ICAR:RS recommendations in the reality of clinical practice is not clearly defined.
An anonymous, web-based survey of the American Rhinologic Society membership was performed in October, 2018. Respondents were asked about the frequency that they recommended the various treatments reviewed in ICAR:RS in the context of medical management for CRS. A 7-point Likert-type scale assessed the frequency of treatment patterns.
A total of 140 members completed the survey (response rate 11.9%). Seventy-two (51.4%) were in practice for 0 to 15 years, 61 (43.6%) completed a rhinology fellowship, and 73 (52.1%) worked in private practice. Disparate treatment patterns were reported for each of the therapies assessed for CRS, including those that were "recommended" or "recommended against" in ICAR:RS. Members with <15 years of experience were more likely to use nasal saline irrigation. Fellowship-trained respondents reported a greater likelihood of using nasal saline irrigation and aspirin desensitization (for patients with aspirin-exacerbated respiratory disease). Practitioners in academic medicine were more likely to utilize aspirin desensitization than those in private practice. Surgeons performing >100 sinus surgeries per year were more likely to use topical antibiotics.
The range of reported treatment patterns identified in this study despite the availability of the ICAR:RS recommendations may suggest the need for improved standardization of CRS management.
《2016年变应性鼻炎和鼻科学国际共识声明：鼻窦炎》（ICAR:RS）是对慢性鼻窦炎（CRS）管理的现有研究和共识建议的综合提炼。然而，ICAR:RS建议在临床实践中的实施情况尚无明确界定。
2018年10月对美国鼻科学会会员进行了一项基于网络的匿名调查。受访者被问及在CRS的药物治疗中，他们推荐ICAR:RS中所审查的各种治疗方法的频率。采用7点李克特量表评估治疗模式的频率。
共有140名会员完成了调查（回复率11.9%）。72名（51.4%）从事临床工作0至15年，61名（43.6%）完成了鼻科学 fellowship，73名（52.1%）在私人诊所工作。对于评估的CRS的每种治疗方法，包括ICAR:RS中“推荐”或“反对推荐”的方法，均报告了不同的治疗模式。经验少于15年的会员更有可能使用鼻腔盐水冲洗。接受过fellowship培训的受访者报告使用鼻腔盐水冲洗和阿司匹林脱敏（用于阿司匹林诱发的呼吸道疾病患者）的可能性更大。学术医学领域的从业者比私人诊所的从业者更有可能采用阿司匹林脱敏。每年进行超过100例鼻窦手术的外科医生更有可能使用局部抗生素。
尽管有ICAR:RS建议，但本研究中所确定的报告治疗模式范围可能表明需要改进CRS管理的标准化。
