Letters to the Editor
In Reply
We would like to thank Mr. Egidi for his letter. His first point is the inconsistency of the prevalence rates reported for chronic rhinosinusitis (CRS) in the literature. The differences depend on whether clinical, endoscopic or CT parameters were used as a basis and in which population the data were collected. According to the GA(2)LEN survey with 57 128 respondents from 12 countries in Europe, the symptom-based prevalence of CRS in the general population is 10.9% (1). In combination with endoscopic and computed tomography findings, the prevalence drops to approximately 5%. The available data show that CRS is more common than generally assumed; it is a relevant condition due to its negative impact on quality of life. In this respect, our evaluation differs from that of Mr. Egidi.
It is true that endoscopy is the only diagnostic modality capable of determining whether there are any lesions in the internal nose, e.g., located in the middle meatus. The above mentioned drop in the prevalence rate associated with adding endoscopy to the diagnostic work-up shows the important role of tendoscopy in differentiating CRS from other conditions, e.g., types of chronic rhinitis. Mr. Egidi rightly points out that a care provision problem arises if not every patient with symptom-based suspicion of CRS can immediately see an ENT specialist. While the definite diagnosis is ultimately established by an ENT specialist, taking nasal endoscopy findings into account, we think it is both appropriate and recommended that the initially seen primary care physician, for example, treats the patient in the meantime with a topical steroid and nasal rinses.
If symptoms persist, an ENT specialist then confirms the diagnosis and, if required, initiates further treatment.
DOI: 10.3238/arztebl.m2024.0244
Corresponding author
PD Dr. med. Tanja Hildenbrand
Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
tanja.hildenbrand@uniklinik-freiburg.de
Conflict of interest
TH received fees for continuing medical education events from Sanofi, Novartis and GSK.
| 1. | Hastan D, Fokkens WJ, Bachert C, et al.: Chronic rhinosinusitis in Europe—an underestimated disease. A GA(2)LEN study. Allergy 2011; 66: 1216–23 CrossRef MEDLINE |
| 2. | Hildenbrand T, Milger-Kneidinger K, Baumann I, Weber R: The diagnosis and treatment of chronic rhinosinusitis. Dtsch Arztebl Int 2024; 121: 643–53 VOLLTEXT |
