The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) has released updated 2025 clinical practice guidelines for the management of adult rhinosinusitis. These guidelines, adopted at Montefiore Einstein well before their official publication, reflect our longstanding commitment to pioneering approaches that advance patient care. They provide a systematic framework for managing chronic rhinosinusitis. The process begins with proper diagnosis, identifying patients with two or more symptoms lasting 12 weeks or longer, including nasal drainage, congestion, facial pain or pressure and decreased sense of smell. The guidelines then outline a clear treatment pathway, from initial medical management with combinations of steroids or antibiotics to surgical intervention and postoperative care. 

“The Academy has documented practices we’ve already been using successfully with patients,” explains Nadeem A. Akbar, MD, FACS, Director of Rhinology and Skull Base Surgery, Otorhinolaryngology – Head and Neck Surgery, Montefiore Einstein and Associate Professor of Otorhinolaryngology – Head and Neck Surgery and Neurological Surgery, Albert Einstein College of Medicine. Beyond clinical protocols, the guidelines will likely help facilitate insurance approval processes, as antibiotics are no longer recommended for patients with chronic rhinosinusitis without acute exacerbation or as a prerequisite for imaging or surgery. “It helps procedures like CT [computed tomography] scans and sinus surgery get approved more easily, so patients don’t face unnecessary administrative delays,” Dr. Akbar explains.

Looking at the broader needs of patients is fundamental to the team’s methodology. Christina H. Fang, MD, Rhinologist at Montefiore Einstein and Assistant Professor of Otorhinolaryngology – Head and Neck Surgery and Neurological Surgery, Albert Einstein College of Medicine, emphasizes the team’s comprehensive approach: “The updated AAO-HNS guidelines emphasize patient education. Surgery is just one of many options we offer, and we do an excellent job guiding our patients through nonsurgical and surgical treatment options so they can make informed decisions.”

The Montefiore Einstein Rhinology and Skull Base Surgery team, comprising fellowship-trained specialists Dr. Fang, Dr. Akbar and Patrick M. Colley, MD, Director, Endoscopic Skull Base Surgery at Montefiore Einstein and Assistant Professor, Otorhinolaryngology, Albert Einstein College of Medicine, bring advanced rhinology and endoscopic skull base surgery expertise to manage even the most complex cases. “Our multidisciplinary team is equipped to offer advanced and complex surgical options for patients who may require specialized rhinologic care,” notes Dr. Fang. 

Leveraging state-of-the-art surgical navigation systems, critical for complex cases, the team offers the full range of minimally invasive procedures, from in-office balloon sinuplasty and radiofrequency ablation for rhinitis to combined open and endoscopic approaches to the skull base. Beyond the operating room, the team works closely with specialists in neurosurgery and allergy. A combined chronic sinusitis and allergy clinic held with allergy specialists enables comprehensive care within a single visit.

Dr. Fang emphasizes the Department’s commitment to collaborative continuity of care, monitoring patients postoperatively before referring patients back to their original physicians for long-term surveillance. Many patients travel from across the region for care. “This continuity avoids travel time for patients who live further away, while ensuring they receive appropriate ongoing care,” she explains. “We stay in close communication with the referring provider, so they can easily reach us should any questions or concerns arise.”

Well before these guidelines were established, the team was applying their principles. Today, they are pushing the field forward through research, including Dr. Fang’s recent analysis of the American Academy of Otolaryngology’s national data registry, encompassing over 19,000 patients with chronic rhinosinusitis with nasal polyposis. This research represents the largest study of its kind, comparing surgical outcomes versus biologic therapy, and will be presented at the upcoming AAO-HNS Annual Meeting in Indianapolis. “Through projects like these, we are demonstrating Montefiore Einstein’s commitment to remaining at the forefront of managing this condition,” she explains.