Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study

Background: Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad accep- tance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. Methods: Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. Results: Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the en- tire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-rela- ted systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consen- sus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. Conclusions: Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient- reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near- consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide- spread acceptance can be developed.