European Position Paper on Rhinosinusitis and Nasal Polyps 2020

doi:10.4193/Rhin20.600

Practice Guideline

. 2020 Feb 20;58(Suppl S29):1-464.

doi: 10.4193/Rhin20.600.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

W J Fokkens¹, V J Lund², C Hopkins³, P W Hellings^{1

4

5}, R Kern⁶, S Reitsma¹, S Toppila-Salmi⁷, M Bernal-Sprekelsen⁸, J Mullol, I Alobid⁹, W Terezinha Anselmo-Lima¹⁰, C Bachert^{5

11}, F Baroody¹², C von Buchwald¹³, A Cervin^{14

15}, N Cohen¹⁶, J Constantinidis¹⁷, L De Gabory¹⁸, M Desrosiers¹⁹, Z Diamant^{20

21

22}, R G Douglas²³, P H Gevaert²⁴, A Hafner²⁵, R J Harvey²⁶, G F Joos²⁷, L Kalogjera^{28

29}, A Knill³⁰, J H Kocks³¹, B N Landis³², J Limpens³³, S Lebeer³⁴, O Lourenco³⁵, C Meco^{36

37}, P M Matricardi³⁸, L O'Mahony³⁹, C M Philpott^{40

41}, D Ryan^{42

43}, R Schlosser⁴⁴, B Senior⁴⁵, T L Smith⁴⁶, T Teeling⁴⁷, P V Tomazic⁴⁸, D Y Wang⁴⁹, D Wang^{50

51}, L Zhang⁵², A M Agius⁵³, C Ahlstrom-Emanuelsson⁵⁴, R Alabri⁵⁵, S Albu⁵⁶, S Alhabash⁵⁷, A Aleksic⁵⁸, M Aloulah⁵⁹, M Al-Qudah⁶⁰, S Alsaleh⁶¹, M A Baban⁶², T Baudoin⁶³, T Balvers⁶⁴, P Battaglia⁶⁵, J D Bedoya⁶⁶, A Beule⁶⁷, K M Bofares⁶⁸, I Braverman⁶⁹, E Brozek-Madry⁷⁰, B Richard⁷¹, C Callejas⁷², S Carrie⁷³, L Caulley⁷⁴, D Chussi⁷⁵, E de Corso⁷⁶, A Coste⁷⁷, U El Hadi⁷⁸, A Elfarouk⁷⁹, P H Eloy⁸⁰, S Farrokhi^{81

82}, G Felisati⁸³, M D Ferrari⁶⁴, R Fishchuk⁸⁴, W Grayson⁸⁵, P M Goncalves⁸⁶, B Grdinic⁸⁷, V Grgic^{28

88}, A W Hamizan⁸⁹, J V Heinichen⁹⁰, S Husain⁹¹, T I Ping⁹², J Ivaska⁹³, F Jakimovska⁹⁴, L Jovancevic⁹⁵, E Kakande⁹⁶, R Kamel⁹⁷, S Karpischenko^{98

99}, H H Kariyawasam¹⁰⁰, H Kawauchi¹⁰¹, A Kjeldsen¹⁰², L Klimek¹⁰³, A Krzeski¹⁰⁴, G Kopacheva Barsova¹⁰⁵, S W Kim¹⁰⁶, D Lal¹⁰⁷, J J Letort¹⁰⁸, A Lopatin^{109

110}, A Mahdjoubi¹¹¹, A Mesbahi¹¹², J Netkovski¹¹³, D Nyenbue Tshipukane¹¹⁴, A Obando-Valverde¹¹⁵, M Okano¹¹⁶, M Onerci¹¹⁷, Y K Ong¹¹⁸, R Orlandi¹¹⁹, N Otori¹²⁰, K Ouennoughy¹²¹, M Ozkan¹²², A Peric¹²³, J Plzak¹²⁴, E Prokopakis¹²⁵, N Prepageran¹²⁶, A Psaltis¹²⁷, B Pugin¹²⁸, M Raftopulos^{1

129}, P Rombaux¹³⁰, H Riechelmann¹³¹, S Sahtout¹³², C-C Sarafoleanu¹³³, K Searyoh¹³⁴, C-S Rhee¹³⁵, J Shi¹³⁶, M Shkoukani¹³⁷, A K Shukuryan¹³⁸, M Sicak¹³⁹, D Smyth¹⁴⁰, K Sindvongs¹⁴¹, T Soklic Kosak¹⁴², P Stjarne¹⁴³, B Sutikno¹⁴⁴, S Steinsvag¹⁴⁵, P Tantilipikorn¹⁴⁶, S Thanaviratananich¹³⁷, T Tran¹⁴⁷, J Urbancic¹⁴⁸, A Valiulius¹⁴⁹, C Vasquez de Aparicio¹⁵⁰, D Vicheva¹⁵¹, P M Virkkula¹⁵², G Vicente¹⁵³, R Voegels¹⁵⁴, M M Wagenmann¹⁵⁵, R S Wardani¹⁵⁶, A Welge-Lussen¹⁵⁷, I Witterick⁷⁴, E Wright¹⁵⁸, D Zabolotniy¹⁵⁹, B Zsolt¹⁶⁰, C P Zwetsloot¹⁶¹

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, University Hospitals Leuven, KU Leuven, Belgium.
⁵ Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium.
⁶ Department of Otorhinolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
⁷ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁸ Department Hospital Quironsalud, University of Valencia, Valencia, Spain.
⁹ Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.
¹⁰ Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA.
¹³ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark.
¹⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital.
¹⁵ Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹⁶ Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
¹⁸ 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.
¹⁹ Department of ORL-HNS, Universite de Montreal, Montreal, Canada.
²⁰ Dept of Respiratory Medicine and Allergology, Skane University in Lund, Sweden.
²¹ Research Director Respiratory and Allergy, at QPS-Netherlands, Groningen, Netherlands.
²² Affiliate to Charles University, Dept of Respiratory Diseases, in Prague, Czech Republic.
²³ Department of Surgery, The University of Auckland, Auckland, New Zealand.
²⁴ Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
²⁵ University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
²⁶ Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia.
²⁷ Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
²⁸ ENT Department, Zagreb School of Medicine.
²⁹ University Hospital Center "Sestre milosrdnice", Zagreb, Croatia.
³⁰ Patient representative, Opuscomms, London, UK.
³¹ Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore.
³² Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland.
³³ Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.
³⁴ Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium.
³⁵ FCS - UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.
³⁶ Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey.
³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
³⁸ Department of Pediatric Pneumology and Immunology, Charite - Universitatsmedizin Berlin, Berlin, Germany.
³⁹ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
⁴⁰ Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
⁴¹ ENT Department, James Paget University Hospital, Great Yarmouth, UK.
⁴² Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴³ Optimum Patient Care, Cambridgeshire, UK.
⁴⁴ Department of Otorhinolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.
⁴⁵ 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.
⁴⁶ Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
⁴⁷ Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands.
⁴⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
⁴⁹ Department of Otorhinolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵⁰ Rhinology Division, ENT Department.
⁵¹ Eye and ENT Hospital, Fudan University, Shanghai, China.
⁵² Department of Otorhinolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China.
⁵³ Department of Medicine and Surgery in the University of Malta.
⁵⁴ ENT-Department, Lund University, Sweden.
⁵⁵ ENT Division, Surgery Department, College of Medicine and Health and Sciences, Sultan Qaboos University, Muscat, Oman.
⁵⁶ Department of Otorhinolaryngology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁵⁷ Department of ENT, Medcare UAE, Dubai.
⁵⁸ ENT Department, University Clinical Centre, University of Banja Luka, Bosnia and Herzegovina.
⁵⁹ ENT Department, King Saud University, Riyadh, Kingdom of Saudi Arabia.
⁶⁰ Department of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan.
⁶¹ Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁶² Department of Otorhinolaryngology - Head and Neck Surgery, University of Sulaimani, Sulaimayniha, Iraq.
⁶³ Dept. of ORL-HNS Sisters of Mercy University Medical Center, School of Medicine University of Zagreb, Croatia.
⁶⁴ Department of Neurology, Leiden University Medical Center (LUMC).
⁶⁵ Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
⁶⁶ Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia.
⁶⁷ Department of Otorhinolaryngology, University Clinic of Munster, Germany.
⁶⁸ Department of Otorhinolaryngology, Omar Al-Moukhtar University, Albyeda, Libya.
⁶⁹ Department of Otorhinolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Israel.
⁷⁰ Department of Otorhinolaryngology, Medical University of Warsaw, Poland.
⁷¹ Department of ENT, Makerere University, Kampala, Uganda.
⁷² Department of Otorhinolaryngology, Pontificia Catholic University, Santiago, Chile.
⁷³ Department of Otorhinolaryngology, Head and Neck Surgery, Newcastle University, United Kingdom.
⁷⁴ Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada.
⁷⁵ Department of Otorhinolaryngology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
⁷⁶ Department of Otorhinolaryngology , La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy.
⁷⁷ ORL et Chirurgie Cervico-Faciale, Universite Paris-Est Creteil (UPEC), France.
⁷⁸ Department of Otorhinolaryngology, American University of Beirut, Lebanon.
⁷⁹ Department of Otorhinolaryngology, Cairo University, Egypt.
⁸⁰ Department of ENT, CHU UCL Namur, Yvoir, Belgium.
⁸¹ Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center.
⁸² The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
⁸³ Department of Head and Neck, University of Milan, Italy.
⁸⁴ Department of ENT- Organs Microsurgery, Central city clinical hospital of lvano-Frankivsk city council, Ivano-Frankivsk, Ukraine.
⁸⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University of Alabama Birmingham, USA.
⁸⁶ ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
⁸⁷ ENT Department, General Hospital, Pula, Pula, Croatia.
⁸⁸ University Hospital center 'Sestre milosrdnice', Zagreb, Croatia.
⁸⁹ Department of Otorhinolaryngology, University Kebangsaan, Kuala Lumpur, Malasyia.
⁹⁰ Department of ENT of Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay.
⁹¹ Department of Otorhinolaryngology, Head and Neck Surgery, National University of Malaysia, Kuala Lumpur, Malaysia.
⁹² Department ORLHNS, University Malaysia Sarawak, Kuching, Malaysia.
⁹³ Clinic of Ear, Nose, Throat and Eye diseases, Vilnius University, Lithuania.
⁹⁴ ENT Department of Medical Faculty, St Cyril and Methodius University of Skopje, North Macedonia.
⁹⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia.
⁹⁶ Department of ENT Surgery, Mulago National Referral Hospital Kampala, Uganda.
⁹⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Cairo University, Egypt.
⁹⁸ ENT Department, Director of Saint Petersburg Research Institute of Ear, Throat , Nose and Speech.
⁹⁹ Professor and Chairman of First Pavlov State Medical University, Saint Petersburg, Russia.
¹⁰⁰ Department of Allergy and Clinical Immunology, Royal National ENT Hospital, London, England.
¹⁰¹ 96. Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan.
¹⁰² Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark.
¹⁰³ Center of Rhinology and Allergology, Wiesbaden, Hesse, Germany.
¹⁰⁴ Department of Otorhinolaryngology, Warsaw Medical University, Warsaw, Poland.
¹⁰⁵ Department of Otorhinolaryngology, University If Medicine, st. Ciril and Methodius, Skopje.
¹⁰⁶ Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University, Seoul, South Korea.
¹⁰⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA.
¹⁰⁸ Department of Otorhinolaryngology, Pontifica Catholic University of Ecuador, Quito, Ecuador.
¹⁰⁹ Department of Otorhinolaryngology, Policlinic No.1- Senior ENT Consultant and Surgeon.
¹¹⁰ President of Russian Rhinologic Society, Moscow, Russia.
¹¹¹ Clinique Mahabi, Setif, Algeria.
¹¹² Department of Facial Surgery, Khodadoust Hospital, Ordibehesht Hospital, Shiraz, Iran.
¹¹³ Department of Otorhinolaryngology-Head and Neck Surgery, St. Cyril and Methodius, Skopje, Republic of North Macedonia.
¹¹⁴ Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
¹¹⁵ Department of Otorhinolaryngology and Surgery, Hospital Mexico, University of Costa Rica, San Jose, Costa Rica.
¹¹⁶ Department of Otorhinolaryngology, International University of Health and Welfare, Narita , Japan.
¹¹⁷ Department of Otorhinolaryngology, Hacettepe, Ankara, Turkey.
¹¹⁸ Department of Otorhinolaryngology, Head and Neck Surgery, University of Singapore, National University Hospital, Singapore.
¹¹⁹ Department of Otorhinolaryngology, University of Utah, Salt Lake City, Utah, USA.
¹²⁰ Department of Otorhinolaryngology at The Jikei University School of Medicine,Tokyo, Japan.
¹²¹ Department of Otorhinolaryngology-Head and Neck Surgery, Saad Dahleb Blida 1, Blida, Algeria.
¹²² Department of Otorhinolaryngology, University of Health Sciences, Ankara City Hospital, Turkey.
¹²³ Department of Otorhinolaryngology, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia.
¹²⁴ Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
¹²⁵ Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
¹²⁶ Department of ENT, University Malaya, Kuala Lumpur, Malaysia.
¹²⁷ Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
¹²⁸ Department of Health Sciences and Technology, ETH Zurich, Switzerland.
¹²⁹ Royal Australian College of Surgeons, Trainee Representative (Australia).
¹³⁰ Department of Otorhinolaryngology, University of Louvain, Brussels, Belgium.
¹³¹ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Baden-Wurttemberg, Germany.
¹³² Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
¹³³ ENT and H NS Department, Santa Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
¹³⁴ Surgery Ear, Nose and Throat Unit, School of Medicine and Dentistry, University of Ghana, Korle-Bu Teaching Hospital, Accra, Ghana.
¹³⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Seoul, Seoul National University, Seoul, Korea.
¹³⁶ Department of Rhinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates.
¹³⁸ Department of Otorhinolaryngology, Yerevan State Medical University, Yerevan, Armenia.
¹³⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital, Slovakia, Slovak Health University Bratislava and Catholic University, Ruzom berok, Slovakia.
¹⁴⁰ Department of Otorhinolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland and University College Cork, Waterford, Ireland.
¹⁴¹ Department of Otorhinolaryngology, Chulalongkorn University, Bangkok, Thailand.
¹⁴² University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
¹⁴³ Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴⁴ Department of Otorhinolaryngology, Head and Neck Surgery, University of Airlangga, Surabaya, Indonesia.
¹⁴⁵ Department of ORL, University of Bergen, Norway.
¹⁴⁶ Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴⁷ Department of ENT Hospital of Ho Chi Minh city, Faculty of medicine of Ho Chi Minh city Vietnam National University, Vietnam.
¹⁴⁸ Department of Otorhinolaryngology and cervicofacial surgery, UMC Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia.
¹⁴⁹ Department of Children's diseases, Vilnius University Medical Faculty, Institute of Clinical Medicine, Vilnius, Lithuania.
¹⁵⁰ Department of Paediatric Surgery, National Hospital Benjamin Bloom, National University of El Salvador, San Salvador, El Salvador.
¹⁵¹ Department of Otorhinolaryngology, Medical University Plovdiv, Bulgaria.
¹⁵² Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki, University Hospital, Helsinki, Finland.
¹⁵³ Department of Otolaryngology, St. Luke's Medical Centre, Quezon City, The Philippines.
¹⁵⁴ Department of Otorhinolaryngology, University of Sao Paulo, Sau Paulo, Brazil.
¹⁵⁵ Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, German.
¹⁵⁶ Department of Otorhinolaryngology Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁵⁷ Department of Otorhinolaryngology, University Hospital Basel, University Basel, Switzerland.
¹⁵⁸ Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
¹⁵⁹ State Institution of O.S. Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
¹⁶⁰ Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary.
¹⁶¹ Department of Neurology, Dijklander Ziekenhuis, Purmerend, The Netherlandsn.

PMID: 32077450
DOI: 10.4193/Rhin20.600

Practice Guideline

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

W J Fokkens et al. Rhinology. 2020.

. 2020 Feb 20;58(Suppl S29):1-464.

doi: 10.4193/Rhin20.600.

Authors

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, University Hospitals Leuven, KU Leuven, Belgium.
⁵ Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium.
⁶ Department of Otorhinolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
⁷ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁸ Department Hospital Quironsalud, University of Valencia, Valencia, Spain.
⁹ Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.
¹⁰ Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA.
¹³ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark.
¹⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital.
¹⁵ Faculty of Medicine, University of Queensland, Brisbane, Australia.
¹⁶ Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
¹⁸ 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.
¹⁹ Department of ORL-HNS, Universite de Montreal, Montreal, Canada.
²⁰ Dept of Respiratory Medicine and Allergology, Skane University in Lund, Sweden.
²¹ Research Director Respiratory and Allergy, at QPS-Netherlands, Groningen, Netherlands.
²² Affiliate to Charles University, Dept of Respiratory Diseases, in Prague, Czech Republic.
²³ Department of Surgery, The University of Auckland, Auckland, New Zealand.
²⁴ Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.
²⁵ University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
²⁶ Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia.
²⁷ Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
²⁸ ENT Department, Zagreb School of Medicine.
²⁹ University Hospital Center "Sestre milosrdnice", Zagreb, Croatia.
³⁰ Patient representative, Opuscomms, London, UK.
³¹ Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore.
³² Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland.
³³ Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.
³⁴ Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium.
³⁵ FCS - UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.
³⁶ Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey.
³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
³⁸ Department of Pediatric Pneumology and Immunology, Charite - Universitatsmedizin Berlin, Berlin, Germany.
³⁹ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
⁴⁰ Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
⁴¹ ENT Department, James Paget University Hospital, Great Yarmouth, UK.
⁴² Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴³ Optimum Patient Care, Cambridgeshire, UK.
⁴⁴ Department of Otorhinolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.
⁴⁵ 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.
⁴⁶ Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
⁴⁷ Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands.
⁴⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
⁴⁹ Department of Otorhinolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵⁰ Rhinology Division, ENT Department.
⁵¹ Eye and ENT Hospital, Fudan University, Shanghai, China.
⁵² Department of Otorhinolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China.
⁵³ Department of Medicine and Surgery in the University of Malta.
⁵⁴ ENT-Department, Lund University, Sweden.
⁵⁵ ENT Division, Surgery Department, College of Medicine and Health and Sciences, Sultan Qaboos University, Muscat, Oman.
⁵⁶ Department of Otorhinolaryngology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁵⁷ Department of ENT, Medcare UAE, Dubai.
⁵⁸ ENT Department, University Clinical Centre, University of Banja Luka, Bosnia and Herzegovina.
⁵⁹ ENT Department, King Saud University, Riyadh, Kingdom of Saudi Arabia.
⁶⁰ Department of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan.
⁶¹ Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁶² Department of Otorhinolaryngology - Head and Neck Surgery, University of Sulaimani, Sulaimayniha, Iraq.
⁶³ Dept. of ORL-HNS Sisters of Mercy University Medical Center, School of Medicine University of Zagreb, Croatia.
⁶⁴ Department of Neurology, Leiden University Medical Center (LUMC).
⁶⁵ Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
⁶⁶ Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia.
⁶⁷ Department of Otorhinolaryngology, University Clinic of Munster, Germany.
⁶⁸ Department of Otorhinolaryngology, Omar Al-Moukhtar University, Albyeda, Libya.
⁶⁹ Department of Otorhinolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Israel.
⁷⁰ Department of Otorhinolaryngology, Medical University of Warsaw, Poland.
⁷¹ Department of ENT, Makerere University, Kampala, Uganda.
⁷² Department of Otorhinolaryngology, Pontificia Catholic University, Santiago, Chile.
⁷³ Department of Otorhinolaryngology, Head and Neck Surgery, Newcastle University, United Kingdom.
⁷⁴ Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada.
⁷⁵ Department of Otorhinolaryngology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
⁷⁶ Department of Otorhinolaryngology , La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy.
⁷⁷ ORL et Chirurgie Cervico-Faciale, Universite Paris-Est Creteil (UPEC), France.
⁷⁸ Department of Otorhinolaryngology, American University of Beirut, Lebanon.
⁷⁹ Department of Otorhinolaryngology, Cairo University, Egypt.
⁸⁰ Department of ENT, CHU UCL Namur, Yvoir, Belgium.
⁸¹ Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center.
⁸² The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
⁸³ Department of Head and Neck, University of Milan, Italy.
⁸⁴ Department of ENT- Organs Microsurgery, Central city clinical hospital of lvano-Frankivsk city council, Ivano-Frankivsk, Ukraine.
⁸⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University of Alabama Birmingham, USA.
⁸⁶ ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
⁸⁷ ENT Department, General Hospital, Pula, Pula, Croatia.
⁸⁸ University Hospital center 'Sestre milosrdnice', Zagreb, Croatia.
⁸⁹ Department of Otorhinolaryngology, University Kebangsaan, Kuala Lumpur, Malasyia.
⁹⁰ Department of ENT of Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay.
⁹¹ Department of Otorhinolaryngology, Head and Neck Surgery, National University of Malaysia, Kuala Lumpur, Malaysia.
⁹² Department ORLHNS, University Malaysia Sarawak, Kuching, Malaysia.
⁹³ Clinic of Ear, Nose, Throat and Eye diseases, Vilnius University, Lithuania.
⁹⁴ ENT Department of Medical Faculty, St Cyril and Methodius University of Skopje, North Macedonia.
⁹⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia.
⁹⁶ Department of ENT Surgery, Mulago National Referral Hospital Kampala, Uganda.
⁹⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Cairo University, Egypt.
⁹⁸ ENT Department, Director of Saint Petersburg Research Institute of Ear, Throat , Nose and Speech.
⁹⁹ Professor and Chairman of First Pavlov State Medical University, Saint Petersburg, Russia.
¹⁰⁰ Department of Allergy and Clinical Immunology, Royal National ENT Hospital, London, England.
¹⁰¹ 96. Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan.
¹⁰² Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark.
¹⁰³ Center of Rhinology and Allergology, Wiesbaden, Hesse, Germany.
¹⁰⁴ Department of Otorhinolaryngology, Warsaw Medical University, Warsaw, Poland.
¹⁰⁵ Department of Otorhinolaryngology, University If Medicine, st. Ciril and Methodius, Skopje.
¹⁰⁶ Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University, Seoul, South Korea.
¹⁰⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA.
¹⁰⁸ Department of Otorhinolaryngology, Pontifica Catholic University of Ecuador, Quito, Ecuador.
¹⁰⁹ Department of Otorhinolaryngology, Policlinic No.1- Senior ENT Consultant and Surgeon.
¹¹⁰ President of Russian Rhinologic Society, Moscow, Russia.
¹¹¹ Clinique Mahabi, Setif, Algeria.
¹¹² Department of Facial Surgery, Khodadoust Hospital, Ordibehesht Hospital, Shiraz, Iran.
¹¹³ Department of Otorhinolaryngology-Head and Neck Surgery, St. Cyril and Methodius, Skopje, Republic of North Macedonia.
¹¹⁴ Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
¹¹⁵ Department of Otorhinolaryngology and Surgery, Hospital Mexico, University of Costa Rica, San Jose, Costa Rica.
¹¹⁶ Department of Otorhinolaryngology, International University of Health and Welfare, Narita , Japan.
¹¹⁷ Department of Otorhinolaryngology, Hacettepe, Ankara, Turkey.
¹¹⁸ Department of Otorhinolaryngology, Head and Neck Surgery, University of Singapore, National University Hospital, Singapore.
¹¹⁹ Department of Otorhinolaryngology, University of Utah, Salt Lake City, Utah, USA.
¹²⁰ Department of Otorhinolaryngology at The Jikei University School of Medicine,Tokyo, Japan.
¹²¹ Department of Otorhinolaryngology-Head and Neck Surgery, Saad Dahleb Blida 1, Blida, Algeria.
¹²² Department of Otorhinolaryngology, University of Health Sciences, Ankara City Hospital, Turkey.
¹²³ Department of Otorhinolaryngology, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia.
¹²⁴ Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
¹²⁵ Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
¹²⁶ Department of ENT, University Malaya, Kuala Lumpur, Malaysia.
¹²⁷ Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
¹²⁸ Department of Health Sciences and Technology, ETH Zurich, Switzerland.
¹²⁹ Royal Australian College of Surgeons, Trainee Representative (Australia).
¹³⁰ Department of Otorhinolaryngology, University of Louvain, Brussels, Belgium.
¹³¹ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Baden-Wurttemberg, Germany.
¹³² Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
¹³³ ENT and H NS Department, Santa Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
¹³⁴ Surgery Ear, Nose and Throat Unit, School of Medicine and Dentistry, University of Ghana, Korle-Bu Teaching Hospital, Accra, Ghana.
¹³⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Seoul, Seoul National University, Seoul, Korea.
¹³⁶ Department of Rhinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹³⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates.
¹³⁸ Department of Otorhinolaryngology, Yerevan State Medical University, Yerevan, Armenia.
¹³⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital, Slovakia, Slovak Health University Bratislava and Catholic University, Ruzom berok, Slovakia.
¹⁴⁰ Department of Otorhinolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland and University College Cork, Waterford, Ireland.
¹⁴¹ Department of Otorhinolaryngology, Chulalongkorn University, Bangkok, Thailand.
¹⁴² University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
¹⁴³ Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴⁴ Department of Otorhinolaryngology, Head and Neck Surgery, University of Airlangga, Surabaya, Indonesia.
¹⁴⁵ Department of ORL, University of Bergen, Norway.
¹⁴⁶ Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴⁷ Department of ENT Hospital of Ho Chi Minh city, Faculty of medicine of Ho Chi Minh city Vietnam National University, Vietnam.
¹⁴⁸ Department of Otorhinolaryngology and cervicofacial surgery, UMC Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia.
¹⁴⁹ Department of Children's diseases, Vilnius University Medical Faculty, Institute of Clinical Medicine, Vilnius, Lithuania.
¹⁵⁰ Department of Paediatric Surgery, National Hospital Benjamin Bloom, National University of El Salvador, San Salvador, El Salvador.
¹⁵¹ Department of Otorhinolaryngology, Medical University Plovdiv, Bulgaria.
¹⁵² Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki, University Hospital, Helsinki, Finland.
¹⁵³ Department of Otolaryngology, St. Luke's Medical Centre, Quezon City, The Philippines.
¹⁵⁴ Department of Otorhinolaryngology, University of Sao Paulo, Sau Paulo, Brazil.
¹⁵⁵ Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, German.
¹⁵⁶ Department of Otorhinolaryngology Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁵⁷ Department of Otorhinolaryngology, University Hospital Basel, University Basel, Switzerland.
¹⁵⁸ Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
¹⁵⁹ State Institution of O.S. Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
¹⁶⁰ Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary.
¹⁶¹ Department of Neurology, Dijklander Ziekenhuis, Purmerend, The Netherlandsn.

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.

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European Position Paper on Rhinosinusitis and Nasal Polyps 2020

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