European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Fokkens WJ 1 , Lund VJ 2 , Hopkins C 3 , Hellings PW 1 , Kern R 4 , Reitsma S 1 Show all authors , Toppila-Salmi S 5 , Bernal-Sprekelsen M 6 , Mullol J , Alobid I 7 , Terezinha Anselmo-Lima W 8 , Bachert C 9 , Baroody F 10 , von Buchwald C 11 , Cervin A 12 , Cohen N 13 , Constantinidis J 14 , De Gabory L 15 , Desrosiers M 16 , Diamant Z 17 , Douglas RG 18 , Gevaert PH 19 , Hafner A 20 , Harvey RJ 21 , Joos GF 22 , Kalogjera L 23 , Knill A 24 , Kocks JH 25 , Landis BN 26 , Limpens J 27 , Lebeer S 28 , Lourenco O 29 , Meco C 30 , Matricardi PM 31 , O'Mahony L 32 , Philpott CM 33 , Ryan D 34 , Schlosser R 35 , Senior B 36 , Smith TL 37 , Teeling T 38 , Tomazic PV 39 , Wang DY 40 , Wang D 41 , Zhang L 42 , Agius AM 43 , Ahlstrom-Emanuelsson C 44 , Alabri R 45 , Albu S 46 , Alhabash S 47 , Aleksic A 48 , Aloulah M 49 , Al-Qudah M 50 , Alsaleh S 51 , Baban MA 52 , Baudoin T 53 , Balvers T 54 , Battaglia P 55 , Bedoya JD 56 , Beule A 57 , Bofares KM 58 , Braverman I 59 , Brozek-Madry E 60 , Richard B 61 , Callejas C 62 , Carrie S 63 , Caulley L 64 , Chussi D 65 , de Corso E 66 , Coste A 67 , El Hadi U 68 , Elfarouk A 69 , Eloy PH 70 , Farrokhi S 71 , Felisati G 72 , Ferrari MD 54 , Fishchuk R 73 , Grayson W 74 , Goncalves PM 75 , Grdinic B 76 , Grgic V 23 , Hamizan AW 77 , Heinichen JV 78 , Husain S 79 , Ping TI 80 , Ivaska J 81 , Jakimovska F 82 , Jovancevic L 83 , Kakande E 84 , Kamel R 85 , Karpischenko S 86 , Kariyawasam HH 87 , Kawauchi H 88 , Kjeldsen A 89 , Klimek L 90 , Krzeski A 91 , Kopacheva Barsova G 92 , Kim SW 93 , Lal D 94 , Letort JJ 95 , Lopatin A 96 , Mahdjoubi A 97 , Mesbahi A 98 , Netkovski J 99 , Nyenbue Tshipukane D 100 , Obando-Valverde A 101 , Okano M 102 , Onerci M 103 , Ong YK 104 , Orlandi R 105 , Otori N 106 , Ouennoughy K 107 , Ozkan M 108 , Peric A 109 , Plzak J 110 , Prokopakis E 111 , Prepageran N 112 , Psaltis A 113 , Pugin B 114 , Raftopulos M 1 , Rombaux P 115 , Riechelmann H 116 , Sahtout S 117 , Sarafoleanu CC 118 , Searyoh K 119 , Rhee CS 120 , Shi J 121 , Shkoukani M 122 , Shukuryan AK 123 , Sicak M 124 , Smyth D 125 , Sindvongs K 126 , Soklic Kosak T 127 , Stjarne P 128 , Sutikno B 129 , Steinsvag S 130 , Tantilipikorn P 131 , Thanaviratananich S 122 , Tran T 132 , Urbancic J 133 , Valiulius A 134 , Vasquez de Aparicio C 135 , Vicheva D 136 , Virkkula PM 137 , Vicente G 138 , Voegels R 139 , Wagenmann MM 140 , Wardani RS 141 , Welge-Lussen A 142 , Witterick I 64 , Wright E 143 , Zabolotniy D 144 , Zsolt B 145 , Zwetsloot CP 146

Affiliations 

  • 1 Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
  • 2 Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
  • 3 Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
  • 4 Department of Otorhinolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
  • 5 Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • 6 Department Hospital Quironsalud, University of Valencia, Valencia, Spain
  • 7 Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
  • 8 Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil
  • 9 Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium
  • 10 Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA
  • 11 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark
  • 12 Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital
  • 13 Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
  • 14 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
  • 15 Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU de Bordeaux, Hospital Pellegrin, Centre F-X Michelet, Bordeaux, France
  • 16 Department of ORL-HNS, Universite de Montreal, Montreal, Canada
  • 17 Dept of Respiratory Medicine and Allergology, Skane University in Lund, Sweden
  • 18 Department of Surgery, The University of Auckland, Auckland, New Zealand
  • 19 Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
  • 20 University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
  • 21 Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia
  • 22 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
  • 23 ENT Department, Zagreb School of Medicine
  • 24 Patient representative, Opuscomms, London, UK
  • 25 Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore
  • 26 Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
  • 27 Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
  • 28 Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
  • 29 FCS - UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
  • 30 Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey
  • 31 Department of Pediatric Pneumology and Immunology, Charite - Universitatsmedizin Berlin, Berlin, Germany
  • 32 Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
  • 33 Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
  • 34 Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  • 35 Department of Otorhinolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
  • 36 UNC Otorhinolaryngology / Head and Neck Surgery, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery and Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
  • 37 Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head Neck Surgery, Oregon Health and Science University, Portland, OR, USA
  • 38 Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands
  • 39 Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
  • 40 Department of Otorhinolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 41 Rhinology Division, ENT Department
  • 42 Department of Otorhinolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China
  • 43 Department of Medicine and Surgery in the University of Malta
  • 44 ENT-Department, Lund University, Sweden
  • 45 ENT Division, Surgery Department, College of Medicine and Health and Sciences, Sultan Qaboos University, Muscat, Oman
  • 46 Department of Otorhinolaryngology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  • 47 Department of ENT, Medcare UAE, Dubai
  • 48 ENT Department, University Clinical Centre, University of Banja Luka, Bosnia and Herzegovina
  • 49 ENT Department, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • 50 Department of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan
  • 51 Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 52 Department of Otorhinolaryngology - Head and Neck Surgery, University of Sulaimani, Sulaimayniha, Iraq
  • 53 Dept. of ORL-HNS Sisters of Mercy University Medical Center, School of Medicine University of Zagreb, Croatia
  • 54 Department of Neurology, Leiden University Medical Center (LUMC)
  • 55 Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
  • 56 Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
  • 57 Department of Otorhinolaryngology, University Clinic of Munster, Germany
  • 58 Department of Otorhinolaryngology, Omar Al-Moukhtar University, Albyeda, Libya
  • 59 Department of Otorhinolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Israel
  • 60 Department of Otorhinolaryngology, Medical University of Warsaw, Poland
  • 61 Department of ENT, Makerere University, Kampala, Uganda
  • 62 Department of Otorhinolaryngology, Pontificia Catholic University, Santiago, Chile
  • 63 Department of Otorhinolaryngology, Head and Neck Surgery, Newcastle University, United Kingdom
  • 64 Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada
  • 65 Department of Otorhinolaryngology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
  • 66 Department of Otorhinolaryngology , La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
  • 67 ORL et Chirurgie Cervico-Faciale, Universite Paris-Est Creteil (UPEC), France
  • 68 Department of Otorhinolaryngology, American University of Beirut, Lebanon
  • 69 Department of Otorhinolaryngology, Cairo University, Egypt
  • 70 Department of ENT, CHU UCL Namur, Yvoir, Belgium
  • 71 Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center
  • 72 Department of Head and Neck, University of Milan, Italy
  • 73 Department of ENT- Organs Microsurgery, Central city clinical hospital of lvano-Frankivsk city council, Ivano-Frankivsk, Ukraine
  • 74 Department of Otorhinolaryngology, Head and Neck Surgery, University of Alabama Birmingham, USA
  • 75 ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
  • 76 ENT Department, General Hospital, Pula, Pula, Croatia
  • 77 Department of Otorhinolaryngology, University Kebangsaan, Kuala Lumpur, Malasyia
  • 78 Department of ENT of Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay
  • 79 Department of Otorhinolaryngology, Head and Neck Surgery, National University of Malaysia, Kuala Lumpur, Malaysia
  • 80 Department ORLHNS, University Malaysia Sarawak, Kuching, Malaysia
  • 81 Clinic of Ear, Nose, Throat and Eye diseases, Vilnius University, Lithuania
  • 82 ENT Department of Medical Faculty, St Cyril and Methodius University of Skopje, North Macedonia
  • 83 Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
  • 84 Department of ENT Surgery, Mulago National Referral Hospital Kampala, Uganda
  • 85 Department of Otorhinolaryngology, Head and Neck Surgery, Cairo University, Egypt
  • 86 ENT Department, Director of Saint Petersburg Research Institute of Ear, Throat , Nose and Speech
  • 87 Department of Allergy and Clinical Immunology, Royal National ENT Hospital, London, England
  • 88 96. Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan
  • 89 Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark
  • 90 Center of Rhinology and Allergology, Wiesbaden, Hesse, Germany
  • 91 Department of Otorhinolaryngology, Warsaw Medical University, Warsaw, Poland
  • 92 Department of Otorhinolaryngology, University If Medicine, st. Ciril and Methodius, Skopje
  • 93 Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University, Seoul, South Korea
  • 94 Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
  • 95 Department of Otorhinolaryngology, Pontifica Catholic University of Ecuador, Quito, Ecuador
  • 96 Department of Otorhinolaryngology, Policlinic No.1- Senior ENT Consultant and Surgeon
  • 97 Clinique Mahabi, Setif, Algeria
  • 98 Department of Facial Surgery, Khodadoust Hospital, Ordibehesht Hospital, Shiraz, Iran
  • 99 Department of Otorhinolaryngology-Head and Neck Surgery, St. Cyril and Methodius, Skopje, Republic of North Macedonia
  • 100 Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
  • 101 Department of Otorhinolaryngology and Surgery, Hospital Mexico, University of Costa Rica, San Jose, Costa Rica
  • 102 Department of Otorhinolaryngology, International University of Health and Welfare, Narita , Japan
  • 103 Department of Otorhinolaryngology, Hacettepe, Ankara, Turkey
  • 104 Department of Otorhinolaryngology, Head and Neck Surgery, University of Singapore, National University Hospital, Singapore
  • 105 Department of Otorhinolaryngology, University of Utah, Salt Lake City, Utah, USA
  • 106 Department of Otorhinolaryngology at The Jikei University School of Medicine,Tokyo, Japan
  • 107 Department of Otorhinolaryngology-Head and Neck Surgery, Saad Dahleb Blida 1, Blida, Algeria
  • 108 Department of Otorhinolaryngology, University of Health Sciences, Ankara City Hospital, Turkey
  • 109 Department of Otorhinolaryngology, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia
  • 110 Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • 111 Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
  • 112 Department of ENT, University Malaya, Kuala Lumpur, Malaysia
  • 113 Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
  • 114 Department of Health Sciences and Technology, ETH Zurich, Switzerland
  • 115 Department of Otorhinolaryngology, University of Louvain, Brussels, Belgium
  • 116 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Baden-Wurttemberg, Germany
  • 117 Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
  • 118 ENT and H NS Department, Santa Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • 119 Surgery Ear, Nose and Throat Unit, School of Medicine and Dentistry, University of Ghana, Korle-Bu Teaching Hospital, Accra, Ghana
  • 120 Department of Otorhinolaryngology, Head and Neck Surgery, Seoul, Seoul National University, Seoul, Korea
  • 121 Department of Rhinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  • 122 Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
  • 123 Department of Otorhinolaryngology, Yerevan State Medical University, Yerevan, Armenia
  • 124 Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital, Slovakia, Slovak Health University Bratislava and Catholic University, Ruzom berok, Slovakia
  • 125 Department of Otorhinolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland and University College Cork, Waterford, Ireland
  • 126 Department of Otorhinolaryngology, Chulalongkorn University, Bangkok, Thailand
  • 127 University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
  • 128 Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
  • 129 Department of Otorhinolaryngology, Head and Neck Surgery, University of Airlangga, Surabaya, Indonesia
  • 130 Department of ORL, University of Bergen, Norway
  • 131 Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 132 Department of ENT Hospital of Ho Chi Minh city, Faculty of medicine of Ho Chi Minh city Vietnam National University, Vietnam
  • 133 Department of Otorhinolaryngology and cervicofacial surgery, UMC Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
  • 134 Department of Children's diseases, Vilnius University Medical Faculty, Institute of Clinical Medicine, Vilnius, Lithuania
  • 135 Department of Paediatric Surgery, National Hospital Benjamin Bloom, National University of El Salvador, San Salvador, El Salvador
  • 136 Department of Otorhinolaryngology, Medical University Plovdiv, Bulgaria
  • 137 Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki, University Hospital, Helsinki, Finland
  • 138 Department of Otolaryngology, St. Luke's Medical Centre, Quezon City, The Philippines
  • 139 Department of Otorhinolaryngology, University of Sao Paulo, Sau Paulo, Brazil
  • 140 Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, German
  • 141 Department of Otorhinolaryngology Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
  • 142 Department of Otorhinolaryngology, University Hospital Basel, University Basel, Switzerland
  • 143 Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
  • 144 State Institution of O.S. Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
  • 145 Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary
  • 146 Department of Neurology, Dijklander Ziekenhuis, Purmerend, The Netherlandsn
Rhinology, 2020 Feb 20;58(Suppl S29):1-464.
PMID: 32077450 DOI: 10.4193/Rhin20.600

Abstract

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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