ABSTRACT
Prior to undertaking primary or revision functional endoscopic sinus surgery (FESS), patients with chronic rhinosinusitis (CRS) should be offered maximal medical therapy1 (see Chapter 3 for a full discussion of medical therapy). Failure to respond to this therapy should be clearly documented in the patient’s chart. The definition of maximal medical therapy is dependent on the subclass of CRS being treated, broadly divided by the presence or absence of nasal polyps. In either case, the clinician should attempt to elicit the patient’s symptoms and classify them according to severity. The total severity can be classified by having patients answer the following question using a visual analogue scale (VAS) graded on a 10 cm scale: ‘How troublesome are your symptoms of rhinosinusitis?’ A VAS score of £3 corresponds to mild, >3-7 corresponds to moderate, and >7 corresponds to severe.2 This will help to guide the clinician in deciding which medical treatments are most appropriate.
