Sinusitis
Sinusitis is defined as "an inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism."[1]
Etiology/causes
Microbiology
Diagnosis
History and physical examination
A systematic review by the Rational Clinical Examination concluded "maxillary toothache, poor response to nasal decongestants, abnormal transillumination, and colored nasal discharge by history or examination are the most useful clinical findings in primary care populations."[2] More recently reported is that a "red streak in the lateral recess of the oropharynx predicts acutesinusitis." (picture)[3]
CT Scan
For acute sinusitis, interpreting abnormal computed tomography scan results is difficult because most patients with a common cold will have abnormalities of the maxillary sinuses.[4]
For chronic sinusitis, computed tomography has many false positive results.[5]
Treatment
Antibiotics
Clinical practice guidelines by the American Academy of Otolaryngology - Head and Neck Surgery address treatment and state:[6]
- "observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3 degrees C or 101 degrees F) and assurance of follow-up"
Patients diagnosed without imaging
One patient in 15 benefit from antibiotics if their diagnosis is based on clinical findings without use of imaging according to one meta-analysis of individual patient data.[7] This number is improved to 8 if there is purulent rhinorrhea.
However, this most recent trial in the meta-analysis[8], and a subsequent trial[7], showed no benefit from amoxicillin.
Regarding choice of antibiotics, a second meta-analysis (not using individual patient data)concluded that respiratory quinolones (moxifloxacin, levofloxacin, or gatifloxacin) were not better than amoxicillin–clavulanate or 2nd and 3rd geneneration cephaolosporings.[9]
Topical corticosteroids do not seem to help patients who are diagnosed without imaging.[8]
Patients diagnosed with imaging
Topical corticosteroids
Topical corticosteroids may improve the resolution or improvement of symptoms.[10]
References
- ↑ National Library of Medicine. Sinusitis. Retrieved on 2007-12-04.
- ↑ Williams JW, Simel DL (1993). "Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination". JAMA 270 (10): 1242–6. PMID 8355389. [e] OVID
- ↑ Thomas C, Aizin V (2006). "Brief report: a red streak in the lateral recess of the oropharynx predicts acute sinusitis". J Gen Intern Med 21 (9): 986–8. DOI:10.1111/j.1525-1497.2006.00498.x. PMID 16918746. Research Blogging.
- ↑ Gwaltney JM, Phillips CD, Miller RD, Riker DK (1994). "Computed tomographic study of the common cold". N. Engl. J. Med. 330 (1): 25–30. PMID 8259141. [e]
- ↑ Ferguson BJ, Narita M, Yu VL, Wagener MM, Gwaltney JM (2012). "Prospective observational study of chronic rhinosinusitis: environmental triggers and antibiotic implications.". Clin Infect Dis 54 (1): 62-8. DOI:10.1093/cid/cir747. PMID 22114094. Research Blogging.
- ↑ Rosenfeld RM, Andes D, Bhattacharyya N, et al (September 2007). "Clinical practice guideline: adult sinusitis". Otolaryngol Head Neck Surg 137 (3 Suppl): S1–31. DOI:10.1016/j.otohns.2007.06.726. PMID 17761281. Research Blogging.
- ↑ 7.0 7.1 Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H et al. (2008). "Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data.". Lancet 371 (9616): 908-14. DOI:10.1016/S0140-6736(08)60416-X. PMID 18342685. Research Blogging. Review in: Evid Based Nurs. 2008 Jul;11(3):78
- ↑ 8.0 8.1 Williamson IG, Rumsby K, Benge S, et al. (December 2007). "Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial". JAMA 298 (21): 2487–96. DOI:10.1001/jama.298.21.2487. PMID 18056902. Research Blogging.
- ↑ Karageorgopoulos, D. E., Giannopoulou, K. P., Grammatikos, A. P., Dimopoulos, G., & Falagas, M. E. (2008). Fluoroquinolones compared with {beta}-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials. CMAJ, 178(7), 845-854. DOI:10.1503/cmaj.071157
- ↑ Zalmanovici A, Yaphe J (2009). "Intranasal steroids for acute sinusitis.". Cochrane Database Syst Rev (4): CD005149. DOI:10.1002/14651858.CD005149.pub3. PMID 19821340. Research Blogging.