Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis

Frank Rikki Canevari; Alessia Giorli; Giulia Monti; Cesare Biagini; Diego Bagnasco; Carlo Cavaliere; Carlotta Pipolo; Eugenio De Corso; Matteo Gelardi; Giulia Gramellini; Alessandro Ioppi; Ignazio La Mantia; Luca Malvezzi; Maurizio Bignami; Puya Dehgani-Mobaraki; Veronica Seccia; Giandomenico Maggiore; Alberto Macchi

doi:10.3389/falgy.2023.1237131

Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis

Front Allergy. 2023 Sep 29:4:1237131. doi: 10.3389/falgy.2023.1237131. eCollection 2023.

Authors

Frank Rikki Canevari^{1

2}, Alessia Giorli³, Giulia Monti⁴, Cesare Biagini³, Diego Bagnasco⁵, Carlo Cavaliere⁶, Carlotta Pipolo⁷, Eugenio De Corso⁸, Matteo Gelardi⁹, Giulia Gramellini¹⁰, Alessandro Ioppi^{1

2

11}, Ignazio La Mantia¹², Luca Malvezzi¹³, Maurizio Bignami¹⁴, Puya Dehgani-Mobaraki¹⁵, Veronica Seccia¹⁶, Giandomenico Maggiore¹⁷, Alberto Macchi⁴

Affiliations

¹ Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
² Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy.
³ Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
⁴ ENT Department, ASST Sette Laghi, University of Insubria, Varese, Italy.
⁵ Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy.
⁶ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
⁷ Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy.
⁸ Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
⁹ Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy.
¹⁰ ENT Deptartement, Asst Grande Ospedale Metropolitano Niguarda, Ear, Nose and Throat Unit of Sant'Orsola-Malpighi Hospital, Bologna, Italy.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.
¹² Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy.
¹³ Otorhinolaryngology, Head and Neck Surgery Unit, Humanitas Research Hospital, IRCCS, Milan, Italy.
¹⁴ Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy.
¹⁵ Ent and Head and Neck Surgery, Usl Umbria 1, Perugia, Italy.
¹⁶ Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
¹⁷ Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy.

Abstract

Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities.

Keywords: CRS; biologic; multidisciplinary; pathway; type 2 crs.