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Surgical Adequacy in ESS for Primary Diffuse CRS: Expert Consensus Recommendations.

Daniela Lucidi1, Carlotta Pipolo2, Fabio Pagella3

  • 1Department of Otolaryngology, Ospedale Santa Maria Delle Croci di Ravenna - Bologna University, Ravenna, Italy.

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|January 14, 2026
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Summary
This summary is machine-generated.

This study establishes surgical guidelines for primary diffuse chronic rhinosinusitis (CRS). Key recommendations include specific endoscopic sinus surgery (ESS) procedures for optimal patient outcomes.

Keywords:
CRSwNPchronic rhinosinusitisendoscopic sinus surgeryethmoidectomyfrontal sinusnasal polyps

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Area of Science:

  • Otolaryngology
  • Surgical Innovation

Background:

  • Primary diffuse chronic rhinosinusitis (CRS) management often requires surgical intervention alongside medical therapy.
  • Current endoscopic sinus surgery (ESS) lacks standardized guidelines for surgical extent in diffuse CRS.

Purpose of the Study:

  • To establish consensus-based guidelines for the surgical extent of ESS in primary diffuse CRS.
  • To promote standardization in surgical approaches for diffuse CRS.

Main Methods:

  • A modified Delphi technique involving 33 statements and an expert panel of 15 ESS specialists.
  • Literature review and consensus meetings to refine and vote on surgical recommendations.

Main Results:

  • Consensus reached on 17 of 34 statements.
  • Recommended procedures include Type 1 medial maxillary antrostomy, bilateral anteroposterior ethmoidectomy, and DRAF I frontal sinusotomy.
  • Mucosal sparing is emphasized; DRAF III frontal sinusotomy and routine sphenoid sinus treatment are not first-line approaches.

Conclusions:

  • A consensus on appropriate surgical approaches for primary diffuse CRS has been established.
  • These guidelines aim to standardize ESS while allowing for clinical judgment.