Recenzija, Prikaz slučaja

Evidence-Based Treatment of Chronic Rhinosinusitis

Livije Kalogjera
Tomislav Baudoini

Sažetak

Although chronic rhinosinusitis is one of the most common chronic disorders, and major advances in minimally invasive surgery and potent antimicrobial and anti-inflammatory conservative treatment have been accomplished in the past decade, evidence for the most effective treatment of chronic rhinosinusitis is still lacking. Randomized controlled trials, which provide the best possible evidence in terms of testing the efficacy of chronic rhinosinusitis treatment, are too few. Those that have been done so far, have proven advantages of endoscopic sinus surgery over classic radical surgery in terms of providing better health related quality of life. Case controlled studies of endoscopic sinus surgery have shown a 91% (73.0%-97.5%) improvement with a major complication rate of 1.6%. Still, at long-term follow up, improvement rate drops to 50% in revision cases and in patients with systemic disease (allergy, asthma). Further improvement in surgical failures can be achieved with long-term topical steroid and low-dose macrolide treatment. Conservative treatment, which includes aggressive long-term steroid and antibiotic therapy, with permanent nasal saline douches and short-term decongestants, has proved successful in half of the treated patients, yet with a shorter follow up. However, only few of clinical trials are randomized controlled trials, and placebo-controlled studies have not recognized significant advantage of any conservative treatment. The level of evidence for the treatment for pediatric sinusitis is satisfactory, and meta-analysis of conservative treatment has been cited in the Cochrane Library Database. Meta-analysis of surgical treatment for pediatric sinusitis yields a success rate of 88% with a mean follow up of 3.7 years and major complication rate of 0.6%.

Ključne riječi

Sinusitis - surgery; Chronic diseases; Evidence based medicine

Hrčak ID:

14244

URI

https://hrcak.srce.hr/14244

Datum izdavanja:

3.3.2005.

Podaci na drugim jezicima: hrvatski

Posjeta: 1.978 *