Controversies in Medical and Surgical Management of Recalcitrant Chronic Rhinosinusitis: What Is the Evidence (2024 AMW)

Management of chronic rhinosinusitis (CRS) recalcitrant to medical and surgical intervention continues to be a challenge. Although recent years have witnessed significant expansion and innovation in our treatment armamentarium for refractory CRS, optimal application of available therapeutic options remains a subject of ongoing debate. The purpose of this panel presentation is to discuss current controversies in medical and surgical management of recalcitrant CRS, with a focus on recently introduced therapies and the relevant evidence. Emerging systemic biologics and their clinical efficacy for various CRS subtypes will be delineated. Controversial aspects of biologic therapy will be addressed; including indications, selection, timing, and tapering with a review of the pertinent literature. In addition, the role of topical antimicrobial agents and long-term macrolide therapy in refractory CRS will be discussed. Current formulations, protocols, risks, benefits, and arguments for and against such treatments will be elucidated along with the corresponding evidence. Furthermore, novel big hole endoscopic surgical approaches for management of recalcitrant CRS will be presented. The indications, techniques, and controversies involved with such revision surgical salvage procedures will be described in conjunction with video presentations. This session will be conducted by academic rhinologists using a multimedia, interactive case-based format with audience polling.