The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. 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. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

1st Department of ORL Head and Neck Surgery Aristotle University AHEPA Hospital Thessaloniki Greece

96 Department of Otorhinolaryngology Shimane University Matsue Shimane Japan

Affiliate to Charles University Dept of Respiratory Diseases Prague Czech Republic

Allergy and Respiratory Research Group Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK

Center of Rhinology and Allergology Wiesbaden Hesse Germany

Clinic of Ear Nose Throat and Eye diseases Vilnius University Lithuania

Clinique Mahabi Setif Algeria

Department Hospital Quironsalud University of Valencia Valencia Spain

Department of Allergy and Clinical Immunology Royal National ENT Hospital London England

Department of Bioscience Engineering University of Antwerp Antwerp Belgium

Department of Children's diseases Vilnius University Medical Faculty Institute of Clinical Medicine Vilnius Lithuania

Department of ENT CHU UCL Namur Yvoir Belgium

Department of ENT Hospital of Ho Chi Minh city Faculty of medicine of Ho Chi Minh city Vietnam National University Vietnam

Department of ENT Makerere University Kampala Uganda

Department of ENT Medcare UAE Dubai

Department of ENT of Hospital de Clinicas Facultad de Ciencias Medicas Universidad Nacional de Asuncion Paraguay

Department of ENT Organs Microsurgery Central city clinical hospital of lvano Frankivsk city council Ivano Frankivsk Ukraine

Department of ENT Surgery Mulago National Referral Hospital Kampala Uganda

Department of ENT University Malaya Kuala Lumpur Malaysia

Department of Facial Surgery Khodadoust Hospital Ordibehesht Hospital Shiraz Iran

Department of Head and Neck University of Milan Italy

Department of Health Sciences and Technology ETH Zurich Switzerland

Department of Immunology and Allergy The Persian Gulf Tropical Medicine Research Center

Department of Inhalation Medicine Observational Pragmatic Research Institute Singapore

Department of Medicine and Surgery in the University of Malta

Department of Medicine Norwich Medical School University of East Anglia Norwich UK

Department of Neurology Dijklander Ziekenhuis Purmerend The Netherlandsn

Department of Neurology Leiden University Medical Center

Department of ORL HNS Universite de Montreal Montreal Canada

Department of ORL University of Bergen Norway

Department of Otolaryngology St Luke's Medical Centre Quezon City The Philippines

Department of Otorhinolaryngology American University of Beirut Lebanon

Department of Otorhinolaryngology Amsterdam University Medical Centres location AMC Amsterdam The Netherlands

Department of Otorhinolaryngology and cervicofacial surgery UMC Ljubljana University of Ljubljana Medical Faculty Ljubljana Slovenia

Department of Otorhinolaryngology and Surgery Hospital Mexico University of Costa Rica San Jose Costa Rica

Department of Otorhinolaryngology at The Jikei University School of Medicine Tokyo Japan

Department of Otorhinolaryngology Cairo University Egypt

Department of Otorhinolaryngology Chulalongkorn University Bangkok Thailand

Department of Otorhinolaryngology Dusseldorf University Hospital Dusseldorf German

Department of Otorhinolaryngology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand

Department of Otorhinolaryngology Ghent University Ghent Belgium

Department of Otorhinolaryngology Hacettepe Ankara Turkey

Department of Otorhinolaryngology Head and Neck Surgery 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Otorhinolaryngology Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Otorhinolaryngology Head and Neck Surgery Ankara University Ankara Turkey

Department of Otorhinolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing China

Department of Otorhinolaryngology Head and Neck Surgery Cairo University Egypt

Department of Otorhinolaryngology Head and Neck Surgery Central Military Hospital Slovakia Slovak Health University Bratislava and Catholic University Ruzom berok Slovakia

Department of Otorhinolaryngology Head and Neck Surgery Cleveland Clinic Abu Dhabi United Arab Emirates

Department of Otorhinolaryngology Head and Neck Surgery Clinical Centre of Vojvodina Faculty of Medicine University of Novi Sad Serbia

Department of Otorhinolaryngology Head and Neck Surgery College of Medicine King Saud University Riyadh Saudi Arabia

Department of Otorhinolaryngology Head and Neck Surgery Dr Cipto Mangunkusumo Hospital University of Indonesia Jakarta Indonesia

Department of Otorhinolaryngology Head and Neck Surgery Helsinki University Hospital Helsinki Finland

Department of Otorhinolaryngology Head and Neck Surgery Hillel Yaffe Medical Center Israel

Department of Otorhinolaryngology Head and Neck Surgery Kyung Hee University Seoul South Korea

Department of Otorhinolaryngology Head and Neck Surgery Mayo Clinic in Arizona Phoenix Arizona USA

Department of Otorhinolaryngology Head and Neck Surgery Medical University of Graz Graz Austria

Department of Otorhinolaryngology Head and Neck Surgery Medical University of South Carolina Charleston USA

Department of Otorhinolaryngology Head and Neck Surgery National University of Malaysia Kuala Lumpur Malaysia

Department of Otorhinolaryngology Head and Neck Surgery Newcastle University United Kingdom

Department of Otorhinolaryngology Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago IL USA

Department of Otorhinolaryngology Head and Neck Surgery Perelman School of Medicine at The University of Pennsylvania Philadelphia PA USA

Department of Otorhinolaryngology Head and Neck Surgery Royal Brisbane and Women's Hospital

Department of Otorhinolaryngology Head and Neck Surgery Royal College of Surgeons in Ireland and University College Cork Waterford Ireland

Department of Otorhinolaryngology Head and Neck Surgery Saad Dahleb Blida 1 Blida Algeria

Department of Otorhinolaryngology Head and Neck Surgery Salzburg Paracelsus Medical University Salzburg Austria

Department of Otorhinolaryngology Head and Neck Surgery Seoul Seoul National University Seoul Korea

Department of Otorhinolaryngology Head and Neck Surgery St Cyril and Methodius Skopje Republic of North Macedonia

Department of Otorhinolaryngology Head and Neck Surgery The University of Chicago Medicine and the Comer Children's Hospital Chicago IL USA

Department of Otorhinolaryngology Head and Neck Surgery University Hospital Ulm Baden Wurttemberg Germany

Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven KU Leuven Belgium

Department of Otorhinolaryngology Head and Neck Surgery University of Adelaide Adelaide Australia

Department of Otorhinolaryngology Head and Neck Surgery University of Airlangga Surabaya Indonesia

Department of Otorhinolaryngology Head and Neck Surgery University of Alabama Birmingham USA

Department of Otorhinolaryngology Head and Neck Surgery University of Ottawa Toronto Canada

Department of Otorhinolaryngology Head and Neck Surgery University of Singapore National University Hospital Singapore

Department of Otorhinolaryngology Head and Neck Surgery University of Southern Denmark Odense Denmark

Department of Otorhinolaryngology Head and Neck Surgery University of Sulaimani Sulaimayniha Iraq

Department of Otorhinolaryngology Head and Neck Surgery University of Szeged Hungary

Department of Otorhinolaryngology International University of Health and Welfare Narita Japan

Department of Otorhinolaryngology Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca Romania

Department of Otorhinolaryngology Jordan University of Science and Technology Irbid Jordan

Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden

Department of Otorhinolaryngology Kilimanjaro Christian Medical University College Moshi Tanzania

Department of Otorhinolaryngology La Fondazione Policlinico Universitario Agostino Gemelli IRCCS Universita Cattolica del Sacro Cuore Rome Italy

Department of Otorhinolaryngology Medical University of Warsaw Poland

Department of Otorhinolaryngology Medical University Plovdiv Bulgaria

Department of Otorhinolaryngology Military Medical Academy Faculty of Medicine University of Defense Belgrade Serbia

Department of Otorhinolaryngology Omar Al Moukhtar University Albyeda Libya

Department of Otorhinolaryngology Policlinic No 1 Senior ENT Consultant and Surgeon

Department of Otorhinolaryngology Pontifica Catholic University of Ecuador Quito Ecuador

Department of Otorhinolaryngology Pontificia Catholic University Santiago Chile

Department of Otorhinolaryngology Universidad de Antioquia Medellin Colombia

Department of Otorhinolaryngology University Clinic of Munster Germany

Department of Otorhinolaryngology University Hospital Basel University Basel Switzerland

Department of Otorhinolaryngology University If Medicine st Ciril and Methodius Skopje

Department of Otorhinolaryngology University Kebangsaan Kuala Lumpur Malasyia

Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Crete Greece

Department of Otorhinolaryngology University of Health Sciences Ankara City Hospital Turkey

Department of Otorhinolaryngology University of Kinshasa Kinshasa Democratic Republic of Congo

Department of Otorhinolaryngology University of Louvain Brussels Belgium

Department of Otorhinolaryngology University of Sao Paulo Sau Paulo Brazil

Department of Otorhinolaryngology University of Utah Salt Lake City Utah USA

Department of Otorhinolaryngology Warsaw Medical University Warsaw Poland

Department of Otorhinolaryngology Yerevan State Medical University Yerevan Armenia

Department of Otorhinolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore

Department of Paediatric Surgery National Hospital Benjamin Bloom National University of El Salvador San Salvador El Salvador

Department of Pediatric Pneumology and Immunology Charite Universitatsmedizin Berlin Berlin Germany

Department of Respiratory Medicine Ghent University Hospital Ghent Belgium

Department of Rhinology The 1st Affiliated Hospital Sun Yat sen University Guangzhou China

Department of Surgery The University of Auckland Auckland New Zealand

Department of Surgery University of Alberta Edmonton Alberta Canada

Department ORLHNS University Malaysia Sarawak Kuching Malaysia

Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland

Dept of ORL HNS Sisters of Mercy University Medical Center School of Medicine University of Zagreb Croatia

Dept of Respiratory Medicine and Allergology Skane University in Lund Sweden

Division of ENT Diseases CLINTEC Karolinska Institute University of Stockholm Stockholm Sweden

Division of Otorhinolaryngology Department of Biotechnology and Life Sciences University of Insubria Varese Italy

Division of Otorhinolaryngology Department of Ophthalmology Otorhinolaryngology Head and Neck Surgery Ribeirao Preto Medical School University of Sao Paulo Sao Paulo Brazil

Division of Rhinology and Sinus Skull Base Surgery Department of Otolaryngology Head Neck Surgery Oregon Health and Science University Portland OR USA

Ear Nose and Throat Department Guys and St Thomas Hospital London United Kingdom

ENT and H NS Department Santa Maria Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania

ENT Department Centro Hospitalar de Entre Douro e Vouga Santa Maria da Feira Portugal

ENT Department Director of Saint Petersburg Research Institute of Ear Throat Nose and Speech

ENT Department General Hospital Pula Pula Croatia

ENT Department James Paget University Hospital Great Yarmouth UK

ENT Department King Saud University Riyadh Kingdom of Saudi Arabia

ENT Department Lund University Sweden

ENT Department of Medical Faculty St Cyril and Methodius University of Skopje North Macedonia

ENT Department University Clinical Centre University of Banja Luka Bosnia and Herzegovina

ENT Department Zagreb School of Medicine

ENT Division Surgery Department College of Medicine and Health and Sciences Sultan Qaboos University Muscat Oman

Eye and ENT Hospital Fudan University Shanghai China

Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia

Faculty of Medicine University of Queensland Brisbane Australia

FCS UBI Faculty of Health Sciences University of Beira Interior Covilha Portugal

Medical Information Specialist Medical Library Amsterdam University Medical Centres location AMC Amsterdam The Netherlands

Optimum Patient Care Cambridgeshire UK

ORL et Chirurgie Cervico Faciale Universite Paris Est Creteil France

Patient representative Opuscomms London UK

Patient representative Task Force Healthcare WTC Den Haag The Netherlands

President of Russian Rhinologic Society Moscow Russia

Professor and Chairman of 1st Pavlov State Medical University Saint Petersburg Russia

Research Director Respiratory and Allergy at QPS Netherlands Groningen Netherlands

Rhinology and Plastic Surgery Unit Otorhinolaryngology Head and Neck Surgery and Pediatric ENT Department CHU de Bordeaux Hospital Pellegrin Centre F 10 Michelet Bordeaux France

Rhinology and Skull Base Department Applied Medical Research Centre UNSW Sydney Australia

Rhinology and Skull Base Unit ENT Department Hospital Clinic de Barcelona Universidad de Barcelona August Pi i Sunyer Biomedical Research Institute Barcelona Spain

Rhinology Division ENT Department

Rhinology Olfactology Unit Otorhinolaryngology Department University Hospital of Geneva Geneva Switzerland

Royal Australian College of Surgeons Trainee Representative

Royal National Throat Nose and Ear Hospital UCLH London UK

Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland

State Institution of O S Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine Kiev Ukraine

Surgery Ear Nose and Throat Unit School of Medicine and Dentistry University of Ghana Korle Bu Teaching Hospital Accra Ghana

The Persian Gulf Biomedical Research Institute Bushehr University of Medical Sciences Bushehr Iran

UNC Otorhinolaryngology Head and Neck Surgery Division of Rhinology Allergy and Endoscopic Skull Base Surgery and Department of Neurosurgery University of North Carolina School of Medicine Chapel Hill NC USA

University Hospital center 'Sestre milosrdnice' Zagreb Croatia

University Hospital Center Sestre milosrdnice Zagreb Croatia

University Medical Centre Ljubljana Department of Otorhinolaryngology and Cervicofacial Surgery University of Ljubljana Faculty of Medicine Ljubljana Slovenia

University of Zagreb Faculty of Pharmacy and Biochemistry Zagreb Croatia

Upper Airways Research Laboratory and ENT Department University Hospital Ghent Ghent Belgium

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