European Position Paper on Rhinosinusitis and Nasal Polyps 2012

Увага! Стаття написана англійською


Rhinosinusitis is a significant health problem which seems to mirror the increasing frequency of allergic rhinitis and which results in a large financial burden on society (1) . The last decade has seen the development of a number of guidelines, consensus documents and position papers on the epidemiology, diagnosis and treatment of rhinosinusitis and nasal polyposis (1-6). In 2005 the first European Position Paper on Rhinosinusitis and Nasal Polyps (EP3 OS) was published (4, 7). This first evidence based position paper was initiated by the European Academy of Allergology and Clinical Immunology (EAACI) to consider what was known about rhinosinusitis and nasal polyps, to offer evidence based recommendations on diagnosis and treatment, and to consider how we could make progress with research in this area. The paper was endorsed by the European Rhinologic Society. Such was the interest in the topic and the increasing number of publications that by 2007 we felt it necessary to update the document: EP3 OS2007 (1, 5). These new publications included some important randomized controlled trials and filled in some of the gaps in our knowledge, which has significantly altered our approach. In particular it has played an important role in the understanding of the management of ARS and has helped to minimize unnecessary use of radiological investigations, overuse of antibiotics, and improve the under utilisation of nasal corticosteroids (8). EP3 OS2007 has had a considerable impact all over the world but as expected with time, many people have requested that we revise it, as once again a wealth of new data has become available in the intervening period. Indeed one of its most important roles has been in the identification of the gaps in the evidence and stimulating colleagues to fill these with high quality studies.

The methodology for EPOS2012 has been the same as for the other two productions. Leaders in the field were invited to critically appraise the literature and write a report on a subject assigned to them. All contributions were distributed before the meeting in November when the group came together in Amsterdam and during the 4 days of the meeting every report was discussed in detail. In addition general discussions on important dilemmas and controversies took place. Finally the management schemes were revised significantly in the light of any new data which was available. Finally we decided to remove the “3” out of EPOS2012 title (EPOS212 instead of EP3 OS2012) to
make it more easy to reproduce. Evidence based medicine is an important method of preparing guidelines. In 1998 the Centre for Evidence Based Medicine (CEBM) published its levels of evidence, which were designed to help clinicians and decision makers to make the most out of the available literature. Recently the levels of evidence were revised in the light of new concepts and data (Table 1). Moreover a number of other systems which grade the quality of evidence and strength of recommendation have been proposed. The most important of these is probably the GRADE initiative (9). For the EPOS2012 we have chosen to collect the evidence using the orginal CEBM format but we plan to update the EPOS2012 clinical recommendations subsequently, following the approach suggested by the GRADE working group.

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