American Rhinologic Society member survey on "maximal medical therapy" for chronic rhinosinusitis

Background: "Maximal medical therapy" is the standard of care for chronic rhinosinusitis (CRS) treatment before the recommendation for surgery. However, this therapy is not consistent. Therefore, as a first step in determining the role of the disparate "maximal medical" treatments for CRS, American Rhinologic Society (ARS) members were surveyed. Methods: A survey was mailed to all nonresident members of the ARS (n = 723). Focusing on the time period before surgical intervention is first considered for CRS patients, the survey assessed types of therapies, frequency of use, details on antibiotic and steroid usage, use of computed tomography (CT), and demographic data of respondents. All responses were anonymous. Results: Three hundred eight surveys were returned (43%). A majority of respondents used oral antibiotics and nasal steroids "almost always (>90%)." Oral antibiotics, oral steroids, nasal steroids, saline irrigation, and allergy testing were most commonly used at least "usually (50-90%)." The median antibiotic length was 3.1-4 weeks. The mean peak prednisone dose was 51.7 mg when oral steroids were used. Therapies that were rarely or never used by the majority included oral antifungals, antifungal spray, antibiotic spray, antibiotic nebulizer, steroid nebulizer, and i.v. antibiotics. Conclusion: Oral antibiotics (median, 3.1-4 weeks) and nasal steroids are used >90% of the time by a majority of ARS members for maximal medical treatment of CRS.