New | CPG: Surgical Management of Chronic Rhinosinusitis

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) published a new Clinical Practice Guideline (CPG) on the Surgical Management of Chronic Rhinosinusitis on May 27 in the June 2025 issue of Otolaryngology–Head and Neck Surgery. This guideline provides clinicians with trustworthy, evidence-based recommendations on the care of adults with chronic rhinosinusitis (CRS).

“Chronic rhinosinusitis doesn’t just affect the nose—it can influence a person’s general life. Patients can struggle with poor sleep, brain fog, depression, anxiety, and reduced productivity that ripples through their relationships and work or school performance,” said Jennifer J. Shin, MD, SM, Chair of the CPG Guideline Development Group. 

Chronic rhinosinusitis affects approximately 11.6% of adults in the United States, resulting in over four million ambulatory visits per year, significantly impacting patients’ quality of life and generating billions in healthcare costs annually. Despite the frequency of endoscopic sinus surgery in clinical practice, there has been notable variation in how and when surgery is performed. This guideline addresses critical questions about patient selection, timing of surgery, and the extent of surgical intervention needed for different CRS subtypes. 

The new CPG offers 11 key action statements addressing aspects of patient care, including verification of CRS diagnosis and assessment of surgical candidacy, appropriate use of antibiotics in CRS management, identifying patients most likely to benefit from surgery versus continued medical therapy, patient education regarding expectations for surgery and long-term management, recommendations regarding surgical techniques for specific CRS subtypes, and more.

"This CPG provides the guidance for developing the needed care pathways for patients who may undergo surgery for CRS, based on current best evidence, such as systematic reviews, meta-analyses, and randomized control trials, as well as observational studies when these were more apt for specific clinical research questions,” said Dr. Shin.

The full KASs and the guideline with other supplemental materials can be found on the Academy’s website at http://www.entnet.org/CPG.

CPG Resources Available Now

• Clinical Practice Guideline
• Executive Summary
• Plain Language Summary
• Key Action Statement Summary and Flowchart
• Patient Handout: FAQs about the Surgical Management of CRS (English and Spanish versions available)
• Handout: Agreement on Expectations of Sinus Surgery
• Handout: Postoperative Instructions and Questions
• Future Research Needs
• Guideline Central: CPG Pocket Guide, App, and Flipbook

Coming Soon

• Podcast: Implications for Otolaryngologists
• Podcast: Implications for Non-otolaryngologists

Authors and Endorsing Societies

The guideline development group consisted of 18 panel members representing experts in specialties and subspecialities encompassing rhinology, comprehensive otolaryngology, otolaryngic allergy, otorhinolaryngological advanced practice provision, as well as a consumer representative.

The CPG authors are: Jennifer J. Shin, MD, SM (chair), Meghan Wilson, MD (assistant chair), Margo McKenna, MD (methodologist), Richard Rosenfeld, MD, MPH, MBA (methodologist), Kathryn Ammon, CRNP, CORLN, Dana Crosby, MD, MPH, Jonathan M. Fuchs, Jason Blakeley Hensler, PA-C, Elisa A. Illing, MD, Kent Lam, MD, Corinna Levine, MD, MPH, Steven T. Kmucha, MD, JD, Edward D. McCoul, MD, MPH, Jessa Miller, MD, Kenneth Rodriguez, MD, Nicholas R. Rowan, MD, Ahmad R. Sedaghat, MD, PhD, Bruce K. Tan, MD, Emma Roy, MS (AAO-HNSF staff), and Nui Dhepyasuwan, MEd (AAO-HNSF staff). 

The CPG for Surgical Management of Chronic Rhinosinusitis is endorsed by:

• American Academy of Otolaryngic Allergy (AAOA)
• American Rhinologic Society (ARS)
• Society of Otorhinolaryngology and Head-Neck Nurses (SOHN)
• Society of Physician Assistants in Otorhinolaryngology-Head & Neck Surgery (SPAO)