Sinusitis: A critical need for further study (original) (raw)
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Classification, Diagnosis and Treatment of Sinusitis: Evidence-Based Clinical Practice Guidelines
Canadian Journal of Infectious Diseases, 1998
OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment of acute, chronic and recurrent acute sinusitis in adults and children.DATA SOURCES: Review articles, textbooks, other published guidelines and recommendations of task force members.STUDY SELECTION: One hundred and seventy-one papers addressing one or all of the objectives.DATA EXTRACTION: Relevant data were collated under each objective.DATA SYNTHESIS: Validity of diagnostic and treatment evidence was assessed by using the methodological recommendations of Sackett et al and the canadian Task Force on Periodic Health Examination, respectively. Where there was a paucity of data, consensus of task force members was reached.CONCLUSIONS: Sinusitis is classified as acute, chronic or recurrent acute disease according to duration and frequency of symptoms and response to therapy (expert opinion). Potential risk factors, concomitant diseases and complications are identified (limited evidence). D...
Journal of Allergy and Clinical Immunology, 1997
States, affecting an estimated 14% of the population. The prevalence of sinusitis is rising. Between 1990 and 1992, persons with sinusitis reported approximately 73 million restricted activity days--an increase from the 50 million restricted activity days reported between 1986 and 1988. Because critical questions remain unanswered about its cause, pathophysiology, and optimal treatment, sinusitis continues to generate significant health care costs and affects the quality of life of a large segment of the U.S. population. To identify critical directions for research on sinus disease, the American Academy of Allergy, Asthma and Immunology and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., convened a meeting in January 1996 in collaboration with the National Institutes of Allergy and Infectious Disease. This document summarizes the proceedings of that meeting and presents what is intended to be the background for future investigation of the many unanswered questions related to sinusitis. (J Allergy Clin Immunol 1997;99: $829-48.)
Management of acute and chronic sinusitis
SA Pharmaceutical Journal, 2017
Sinusitis is a common condition for which patients often consult the community pharmacist. It is, however, challenging to differentiate between common forms of sinusitis as they have nearly identical clinical representations. This review article provides an overview of sinusitis, classification, differential diagnosis between viral sinusitis, bacterial sinusitis and chronic rhinosinusitis, therapeutic management, patient education and patient referral guidelines. In addition, the recently updated guidelines on sinusitis published by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (2015), the European position paper on rhinosinusitis and nasal polyps, EPOS 2012 and the Canadian guidelines for acute bacterial rhinosinusitis (2014) will be reviewed.
Acute sinusitis: pitfalls in diagnosis and management
Clinical Risk, 2010
Acute sinusitis is one of the most common conditions that can present to a wide variety of clinicians ranging from general practitioners, Accident and Emergency, physicians, ophthalmologists and otolaryngologists to intensivists and even neurosurgeons. Delayed diagnosis with failure to recognize and manage (albeit rare) complications can be devastating for patients, potentially resulting in blindness or even death. Management of the condition itself can lead to complications. This article reviews the current guidelines for diagnosis and management of acute sinusitis with emphasis on medicolegal aspects. Adverse events affecting patients with acute sinusitis are also presented illustrating the challenges in the assessment and management of this condition.
Chronic sinusitis refractory to standard management in patients with humoral immunodeficiencies
Clinical and Experimental Immunology, 1997
Chronic refractory sinusitis is a common feature in patients with primary immunodeficiencies. The efficacy of standard therapeutic strategies is questionable. In an open trial we evaluated the efficacy of azithromycin, N-acetylcysteine and topical intranasal beclomethasone (100 mg twice daily for 6 weeks) in 16 patients with primary immunodeficiencies (median age 13 . 5 years, range 5-32 years). All patients suffered from chronic sinusitis despite regular immunoglobulin replacement therapy every 3 weeks. Magnetic resonance imaging (MRI) scans were performed before and after 6 weeks of treatment to evaluate morphological changes in the paranasal sinuses. Nasal swabs and washings were taken for microbial analysis and measurement of inflammatory mediators (IL-8, tumour necrosis factor-alpha (TNF-a), eosinophilic cationic protein (ECP)) before and post therapy. Inflammatory mediators in nasal secretions were significantly elevated in patients: IL-8 median 2436 pg/ml (range 441-5435 pg/ml), TNF-a 37 . 3 pg/ml (3 . 75-524 pg/ml) and ECP 33 ng/ml (1 . 5-250 ng/ml) versus age-matched healthy controls: IL-8 median 212 pg/ml (99-825 pg/ml), TNF-a 3 . 77 pg/ml (2 . 8-10 . 2 pg/ml) and ECP 1 . 5 ng/ ml (1 . 5-14 . 8 ng/ml) (P < 0 . 0001). Inflammation of the maxillary sinuses was confirmed by MRI scans in all patients, additionally infection of the ethmoidal and frontal sinuses was recorded in five patients. Bacterial growth appeared in 11 out of 16 cultures. In spite of therapy, no improvement in sinal inflammation visualized by MRI was achieved. Moreover, no significant decrease in pathogens and levels of inflammatory mediators could be detected (IL-8 1141 pg/ml, 426-4556 pg/ml; TNF-a 13 . 9 pg/ ml, 4 . 1-291 . 6 pg/ml; ECP 32 . 3 ng/ml, 3 . 7-58 . 4 ng/ml). Our results demonstrate that conventional management of sinusitis is of little benefit in patients with chronic refractory sinusitis with an underlying immunodeficiency. More studies are needed to test antibiotic regimens, probably combined with surgical drainage and anti-inflammatory agents.
Determinants for the course of acute sinusitis in adult general practice patients
Postgraduate Medical Journal, 2001
Background-Although the prognosis of acute sinusitis is important, little is known about it and the factors predicting its course in a general practice population. Objective-To determine the course of acute sinusitis and factors predicting it in adults in general practice. Methods-The prognostic value of demographic and clinical factors and the patient's emotional state, for example anxious or depressed, were determined prospectively by means of multivariate analysis. Main outcome measurements-Resolution of facial pain, resumption of daily activities, and the patient's reported improvement. Factors with a significant predictive value were used to classify the patients into three diVerent groups: quick, moderate, and slow recovery. Results-The median time from enrolment to recovery was six (range percentile 25-75: 4-10) days in a population of 177 patients. Factors predictive of a prolonged clinical course were: female sex (hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.42 to 0.83), history longer than 14 days before inclusion (HR 0.62; 95% CI 0.41 to 0.94), headache, cold, or cough as a reason for the encounter (HR 0.65; 95% CI 0.44 to 0.96), and absence of cervical adenopathy (HR 0.71; 95% CI 0.51 to 0.96). Antibiotic treatment did not influence the course of disease. The median time to recovery was three days for patients with a quick, five days for those with a moderate, and seven days for those with a slow recovery. Conclusion-In general practice acute sinusitis is mostly a self limiting disease. A limited number of characteristics are predictive of a (slightly) prolonged clinical course of acute sinusitis in general practice.