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COVID-19 and chronic rhinosinusitis: management and comorbidity - what have we learned?
L Klimek1, J Hagemann2, T Huppertz2
1Center for Rhinology and Allergology, Wiesbaden, Germany.
Insights
Chronic rhinosinusitis (CRS) affects millions globally and is a COVID-19 risk factor. Treatment focuses on intranasal corticosteroids, with surgery reserved for complications, and careful management of biologics during SARS-CoV-2 infection.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Respiratory Medicine
Background:
- Chronic rhinosinusitis (CRS) affects 5%-12% of the global population.
- CRS is a chronic respiratory disease and a potential risk factor for COVID-19 patients.
- Management strategies for CRS during the COVID-19 pandemic require specific considerations.
Purpose of the Study:
- To review and discuss the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) during the COVID-19 pandemic.
- To provide guidance on managing CRSwNP in light of the SARS-CoV-2 pandemic.
- To inform future pandemic preparedness for CRS treatment.
Main Methods:
- A non-systematic literature search was conducted on COVID-19 and CRSwNP treatment.
- International publications, medical databases, guidelines, and internet resources were reviewed.
- Clinical experience was incorporated due to limited specific publications.
Main Results:
- Intranasal corticosteroids are the standard treatment for CRS in SARS-CoV-2 infected patients.
- Surgical indications for CRS require critical evaluation, reserved for complications or refractory cases.
- Systemic corticosteroids should be avoided; biological treatments require careful monitoring and potential interruption during COVID-19 infection.
Conclusions:
- Current CRS treatment guidelines emphasize intranasal corticosteroids for patients with SARS-CoV-2 infection.
- Surgical interventions for CRS during the pandemic necessitate careful risk-benefit assessment and appropriate personal protective equipment.
- Management of biological therapies for CRS must be individualized based on COVID-19 status and patient monitoring.
Introduction:
Approximately 5%-12% of the population worldwide suffer from chronic rhinosinusitis (CRS). CRS is defined as a chronic respiratory disease and is considered to be a risk factor for COVID-19 patients.
Areas Covered:
A non-systematic literature research was conducted on COVID-19 and treatment options for CRSwNP. The latest international publications in medical databases, international guidelines, and the internet were reviewed. Since there were no publications on all aspects of this topic during the pandemic, we included our own experience in this report. Based on the conducted literature research in addition to our previously reported experience, we discuss the treatment of CRSwNP during the COVID-19 pandemic and what can be taken for future pandemics.
Expert Opinion:
Intranasal corticosteroids remain the standard treatment for CRS in patients with SARS-CoV-2 infection. Indications for surgical treatment of CRS should be critically evaluated and reserved for patients with complications and those with no other treatment options. For this purpose, COVID-19 status should be known if possible and, in case of unclear status (emergency), using appropriate personal protective equipment. Systemic corticosteroids should be avoided were possible. Biological treatment should be continued under careful monitoring in uninfected patients and should be temporarily interrupted during COVID-19 infection.
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