According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020), the diagnosis of chronic rhinosinusitis without polyps (CRSwNP negative) requires symptoms for >12 weeks AND which objective criteria?
- A Positive skin prick test for aeroallergens plus elevated serum IgE >200 IU/mL
- B Endoscopic signs (mucosal edema, discharge, polyps in middle meatus) OR CT changes (mucosal thickening >4 mm) — at least one objective sign is required in addition to symptoms ✓
- C CT staging score of Lund-Mackay ≥12 alone, regardless of endoscopic findings
- D Culture-positive nasal swab for S. aureus or H. influenzae in addition to symptom duration
Explanation
EPOS 2020 defines CRS as inflammation of the nose and paranasal sinuses characterized by ≥2 symptoms (one must be nasal obstruction/discharge) for >12 weeks PLUS objective evidence: endoscopic signs (polyps, mucopurulent discharge, oedema in the middle meatus/ethmoid) OR CT mucosal changes (Lund-Mackay scoring). Symptom duration alone is insufficient. The Lund-Mackay score aids in staging (0-24, with scores ≥4 generally correlating with disease severity), but no single threshold is required for diagnosis. Allergy testing is relevant for allergic rhinosinusitis but not required for CRS diagnosis.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.