Sinusitis: Difference between revisions

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===CT Scan===
===CT Scan===
Interpreting abnormal CT scan results is difficult because most patients with a common cold will have abnormalities of the maxillary sinuses.<ref name="pmid8259141">{{cite journal |author=Gwaltney JM, Phillips CD, Miller RD, Riker DK |title=Computed tomographic study of the common cold |journal=N. Engl. J. Med. |volume=330 |issue=1 |pages=25–30 |year=1994 |pmid=8259141 |doi=|url=http://content.nejm.org/cgi/content/full/330/1/25}}</ref>
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.<ref name="pmid8259141">{{cite journal |author=Gwaltney JM, Phillips CD, Miller RD, Riker DK |title=Computed tomographic study of the common cold |journal=N. Engl. J. Med. |volume=330 |issue=1 |pages=25–30 |year=1994 |pmid=8259141 |doi=|url=http://content.nejm.org/cgi/content/full/330/1/25}}</ref>
 
For chronic sinusitis, [[computed tomography]] has many false positive results.<ref name="pmid22114094">{{cite journal| author=Ferguson BJ, Narita M, Yu VL, Wagener MM, Gwaltney JM| title=Prospective observational study of chronic rhinosinusitis: environmental triggers and antibiotic implications. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 1 | pages= 62-8 | pmid=22114094 | doi=10.1093/cid/cir747 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22114094  }} </ref>


==Treatment==
==Treatment==
===Patients diagnosed ''without'' using imaging===
===Antibiotics===
One patient in 15 benefit from [[antibiotic]]s if their diagnosis is based on clinical findings without use of imaging.<ref>Young et al (2008). Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet {{doi|10.1016/S0140-6736(08)60416-X}}</ref><ref name="pmid18056902">{{cite journal |author=Williamson IG, Rumsby K, Benge S, ''et al'' |title=Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial |journal=JAMA |volume=298 |issue=21 |pages=2487–96 |year=2007 |pmid=18056902 |doi=10.1001/jama.298.21.2487|url=http://jama.ama-assn.org/cgi/content/full/298/21/2487}}</ref> This number is improved to 8 if there is purulent rhinorrhea.
[[Clinical practice guideline]]s by the Infectious Diseases Society of America recommend treatment if one of:<ref name="pmid22438350">{{cite journal| author=Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA et al.| title=IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= e72-e112 | pmid=22438350 | doi=10.1093/cid/cir1043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22438350  }} </ref>
* "Onset with ''persistent'' symptoms or signs compatible with acute rhinosinusitis, lasting for ≥10 days without any evidence of clinical improvement"
* "Onset with severe symptoms or signs of high fever (≥39°C [102°F]) and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive                                    days at the beginning of illness"
* "Onset with ''worsening'' symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral                                    upper respiratory infection (URI) that lasted 5–6 days and were initially improving (“double-sickening”)"
 
[[Clinical practice guideline]]s by the  American Academy of Otolaryngology - Head and Neck Surgery address treatment and state:<ref name="pmid17761281">{{cite journal |author=Rosenfeld RM, Andes D, Bhattacharyya N, ''et al'' |title=Clinical practice guideline: adult sinusitis |journal=Otolaryngol Head Neck Surg |volume=137 |issue=3 Suppl |pages=S1–31 |year=2007 |month=September |pmid=17761281 |doi=10.1016/j.otohns.2007.06.726 |url=http://linkinghub.elsevier.com/retrieve/pii/S0194-5998(07)01449-0 |issn=}}</ref>
* "observation without use of [[antibiotic]]s 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====
Many meta-analyses of this topic have been done.<ref name="pmid22450938">{{cite journal| author=Smith SR, Montgomery LG, Williams JW| title=Treatment of mild to moderate sinusitis. | journal=Arch Intern Med | year= 2012 | volume= 172 | issue= 6 | pages= 510-3 | pmid=22450938 | doi=10.1001/archinternmed.2012.253 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22450938  }} </ref>
 
One patient in 15 benefit from [[antibiotic]]s if their diagnosis is based on clinical findings without use of imaging according to one [[meta-analysis]] of individual patient data.<ref name="pmid18342685">{{cite journal| author=Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H et al.| title=Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. | journal=Lancet | year= 2008 | volume= 371 | issue= 9616 | pages= 908-14 | pmid=18342685 | doi=10.1016/S0140-6736(08)60416-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18342685  }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18583490 Review in: Evid Based Nurs. 2008 Jul;11(3):78] </ref> This number is improved to 8 if there is purulent rhinorrhea.
 
However, this most recent trial in the meta-analysis<ref name="pmid18056902">{{cite journal |author=Williamson IG, Rumsby K, Benge S, ''et al.'' |title=Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial |journal=JAMA |volume=298 |issue=21 |pages=2487–96 |year=2007 |month=December |pmid=18056902 |doi=10.1001/jama.298.21.2487 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18056902 |issn=}}</ref>, and a subsequent trial<ref name="pmid18342685">{{cite journal| author=Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H et al.| title=Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. | journal=Lancet | year= 2008 | volume= 371 | issue= 9616 | pages= 908-14 | pmid=18342685 | doi=10.1016/S0140-6736(08)60416-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18342685  }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18583490 Review in: Evid Based Nurs. 2008 Jul;11(3):78] </ref>, 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.<ref>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}}</ref>


Topical [[corticosteroid]]s do not seem to help patients who are diagnosed without imaging.<ref name="pmid18056902"/>
Topical [[corticosteroid]]s do not seem to help patients who are diagnosed without imaging.<ref name="pmid18056902"/>


===Patients diagnosed ''with'' using imaging===
====Patients diagnosed ''with'' imaging====
 
===Topical corticosteroids===
Topical [[corticosteroid]]s may improve the resolution or improvement of symptoms.<ref name="pmid22585889">{{cite journal| author=Hayward G, Heneghan C, Perera R, Thompson M| title=Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis. | journal=Ann Fam Med | year= 2012 | volume= 10 | issue= 3 | pages= 241-9 | pmid=22585889 | doi=10.1370/afm.1338 | pmc=PMC3354974 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22585889  }} </ref><ref name="pmid19821340">{{cite journal| author=Zalmanovici A, Yaphe J| title=Intranasal steroids for acute sinusitis. | journal=Cochrane Database Syst Rev | year= 2009 | volume=  | issue= 4 | pages= CD005149 | pmid=19821340
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19821340 | doi=10.1002/14651858.CD005149.pub3 }}</ref>


==References==
==References==
<references/>
<references/>

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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 Infectious Diseases Society of America recommend treatment if one of:[6]

  • "Onset with persistent symptoms or signs compatible with acute rhinosinusitis, lasting for ≥10 days without any evidence of clinical improvement"
  • "Onset with severe symptoms or signs of high fever (≥39°C [102°F]) and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness"
  • "Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection (URI) that lasted 5–6 days and were initially improving (“double-sickening”)"

Clinical practice guidelines by the American Academy of Otolaryngology - Head and Neck Surgery address treatment and state:[7]

  • "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

Many meta-analyses of this topic have been done.[8]

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.[9] This number is improved to 8 if there is purulent rhinorrhea.

However, this most recent trial in the meta-analysis[10], and a subsequent trial[9], 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.[11]

Topical corticosteroids do not seem to help patients who are diagnosed without imaging.[10]

Patients diagnosed with imaging

Topical corticosteroids

Topical corticosteroids may improve the resolution or improvement of symptoms.[12][13]

References

  1. ↑ National Library of Medicine. Sinusitis. Retrieved on 2007-12-04.
  2. ↑ 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
  3. ↑ 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.
  4. ↑ 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]
  5. ↑ 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.
  6. ↑ Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA et al. (2012). "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults.". Clin Infect Dis 54 (8): e72-e112. DOI:10.1093/cid/cir1043. PMID 22438350. Research Blogging.
  7. ↑ 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.
  8. ↑ Smith SR, Montgomery LG, Williams JW (2012). "Treatment of mild to moderate sinusitis.". Arch Intern Med 172 (6): 510-3. DOI:10.1001/archinternmed.2012.253. PMID 22450938. Research Blogging.
  9. ↑ 9.0 9.1 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
  10. ↑ 10.0 10.1 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.
  11. ↑ 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
  12. ↑ Hayward G, Heneghan C, Perera R, Thompson M (2012). "Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis.". Ann Fam Med 10 (3): 241-9. DOI:10.1370/afm.1338. PMID 22585889. PMC PMC3354974. Research Blogging.
  13. ↑ 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.
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