Management of Recurrent Acute Rhinosinusitis: A Systematic Review.

Area of Science:

• Otolaryngology
• Allergy and Immunology
• Medical Research

Background:

• Recalcitrant Allergic Rhinosinusitis (RARS) presents a significant clinical challenge.
• Optimal management strategies for RARS remain an area of active investigation.

Purpose of the Study:

• To systematically review the existing literature on the management of Recalcitrant Allergic Rhinosinusitis (RARS).
• To identify and evaluate current treatment options and their efficacy.

Main Methods:

• A comprehensive literature search was conducted across major databases (Cochrane, PubMed, EMBASE) from 1990 to the present.
• Studies were included if they specifically addressed RARS management, involved at least three patients, and were published in English, adhering to PRISMA guidelines.
• Evidence levels ranged from Level 2 to Level 4, with a total of 10 studies meeting the inclusion criteria.

Main Results:

• Ten studies involving 890 patients were reviewed, with follow-up periods ranging from 1 to 19 months.
• Management options included medical therapy, balloon sinus dilation (BSD), and endoscopic sinus surgery (ESS).
• Surgical interventions (BSD and ESS) demonstrated a trend towards better symptom control compared to medical management alone, though meta-analysis was not feasible.

Conclusions:

• There is a lack of definitive consensus on the optimal treatment for RARS.
• Current literature, primarily based on expert opinion, suggests that surgical interventions like BSD or ESS may be beneficial for patients refractory to medical management.
• These surgical approaches may improve symptoms and enhance the quality of life for individuals with RARS.