Comprehensive management of

Acute RHinosinusitis
Based on EPOS 2020
Nur Qamariah
Departemen THT RSUD Ulin Banjarmasin
Fakultas Kedokteran Universitas Lambung Mangkurat
 Introduction
● Rhinosinusitis is a common condition in most of the
world à Healthcare consumption & productivity
loss
● ARS has prevalence of 6-15% per year
● ARS is usually a self limiting disease but serious
complication can lead to a life threatening situations
● One of the common reasons for prescription of
antibiotics and lead to global crisis of resistance to
antibiotics

The core objective of the EPOS2020 guideline is to provide revised, up-to-date and
clear evidence-based recommendations and integrated care pathways in ARS and CRS.

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 Definition

Adults
Sudden onset of two or more symptoms, one of which
should be either

• Nasal blockage/ obstruction/ congestion or nasal

discharge (anterior/ posterior nasal drip):
• ± facial pain/pressure
• ± reduction or loss of smell and either

For <12 weeks; with symptoms free interval if the problem is

current

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 Definition

Children
Sudden onset of two or more of the symptoms

• Nasal blockage/ obstruction/ congestion

• Discoloured nasal discharge (anterior/ posterior nasal drip)
• Cough

For <12 weeks; with symptoms free interval if the problem is current

Questions on allergic symptoms (i.e. sneezing, watery

rhinorrhoea, nasal itching, and itchy watery eyes) should be included.

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 Classification

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 ETIOLOGI

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 CLINICAl
manifestation

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 Factors associated with ars & RARS

01 02 03 04

Environmental Exposure Anatomical factors Allergy Smoking

05 06 07 08

Ciliary impairment Primary Cilia Dyskinesia Laryngopharyngeal reflux Anxiety and Depression

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 EPOS 2020 : Care pathways for acute rhinosinusitis

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and
Nasal Polyps 2020. Rhinol J. 2020; 58(Suppl S29):1-464. doi:10.4193/Rhin20.600
 Summary
1. Acute rhinosinusitis based on duration and severity of the symptoms is divided into
• viral common cold
• post-viral
• acute bacterial rhinosinusitis

2. There have been some recent studies supporting the symptom base, but more are required
to reduce the inappropriate use of antibiotics

3. Management guidelines of acute rhinosinusitis is divided to three care section :

• Self Care
• Primary Care
• Secondary/Tertiary Care
Thank you