title: Indications for image-guided sinus surgery: the current evidence.
abstract: BACKGROUND
  Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence supporting the indications for image guidance in sinus surgery, examining two important questions: (1) Does image-guided sinus surgery (IGSS) reduce complication rates? (2) Does IGSS improve clinical outcomes?
  
  
  METHODS
  Primary research articles evaluated for this report were identified using appropriate search terms and a PubMed search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines: level 1 = randomized trials, level 2 = prospective cohort studies with comparison group, level 3 = case-control studies, level 4 = retrospective case series, and level 5 = expert opinion.
  
  
  RESULTS
  We identified 105 articles for full review and highlight 5 articles in our report. Primarily, there is expert opinion (level 5) and case series (level 4) with and without comparison groups supporting the indications for IGSS. In addition, authors point out that sample size and design issues preclude definitive randomized trials using IGSS.
  
  
  CONCLUSIONS
  Although randomized trials of IGSS are not practical, ethical, or feasible, clinical experience, expert opinion, and case series support the current indications for IGSS. Studies designed to draw conclusions about the role of IGSS in decreasing major complications of sinus surgery are not possible.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA. smithtim@ohsu.edu
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.forename: Michael G
authors.initials: MG
authors.lastname: Stewart
authors.forename: Richard R
authors.initials: RR
authors.lastname: Orlandi
authors.forename: Michael
authors.initials: M
authors.lastname: Setzen
authors.forename: Donald C
authors.initials: DC
authors.lastname: Lanza
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D016343:Monitoring, Intraoperative; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D025321:Surgery, Computer-Assisted / Q000379:methods