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      Saline irrigation for chronic rhinosinusitis

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          Abstract

          This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Nasal saline irrigation is commonly used to improve patient symptoms.

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          Most cited references64

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          Bias in meta-analysis detected by a simple, graphical test

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            Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes.

            The objective of this review is to summarize recommendations on methods for evaluating responsiveness and minimal important difference (MID) for patient-reported outcome (PRO) measures. We review, summarize, and integrate information on issues and methods for evaluating responsiveness and determining MID estimates for PRO measures. Recommendations are made on best-practice methods for evaluating responsiveness and MID. The MID for a PRO instrument is not an immutable characteristic, but may vary by population and context, and no one MID may be valid for all study applications. MID estimates should be based on multiple approaches and triangulation of methods. Anchor-based methods applying various relevant patient-rated, clinician-rated, and disease-specific variables provide primary and meaningful estimates of an instrument's MID. Results for the PRO measures from clinical trials can also provide insight into observed effects based on treatment comparisons and should be used to help determine MID. Distribution-based methods can support estimates from anchor-based approaches and can be used in situations where anchor-based estimates are unavailable. We recommend that the MID is based primarily on relevant patient-based and clinical anchors, with clinical trial experience used to further inform understanding of MID.
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              European Position Paper on Rhinosinusitis and Nasal Polyps 2012.

              The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, 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. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.
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                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley
                14651858
                April 26 2016
                Affiliations
                [1 ]UK Cochrane Centre; Oxford UK
                [2 ]Guy's Hospital; ENT Department; Gerat Maze Pond London UK SE1 9RT
                [3 ]Norwich Medical School, University of East Anglia; Department of Medicine; Norwich UK NR4 7TJ
                [4 ]Brighton and Sussex Medical School; Division of Primary Care and Public Health; Brighton UK BN1 9PH
                [5 ]Royal National Throat, Nose & Ear Hospital; Department of Rhinology; Grays Inn Road London UK WC1X 8DA
                [6 ]Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
                Article
                10.1002/14651858.CD011995.pub2
                27115216
                a8d12eb0-1665-4979-9e55-381e1010c9cf
                © 2016
                History

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