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rhinosinusitis

Clinical manifestations: - rhinitis - nasal obstruction - purulent mucus in the middle meatus - anterior or posterior mucopurulent drainage - polyps in the nasal cavity or middle meatus - decreased sense of smell - sinusitis - facial pain, pressure or fullness - purulent mucus in the ethmoid sinus : - chronic rhinosinusitis - 12 weeks duration - >= 2 of - facial pain, pressure or fullness - nasal obstruction - purulent mucus in the middle meatus - anterior or posterior mucopurulent drainage - decreased sense of smell - recurrent rhinosinusitis - >= 4 episodes/year of acute bacterial rhinosinusitis occur without signs/symptoms of rhinosinusitis between episodes Laboratory: - nasal swabs* - microscopy - bacterial culture - fungal culture * meets diagnostic criteria Special laboratory: - nasal & sinus endoscopy with biopsy* * meets diagnostic criteria Radiology: - CT of paranasal sinuses - imaging showing inflammation of the paranasal sinuses* * meets diagnostic criteria Management: - nasal glucocorticoids first line treatment - improve nasal congestion - do not improve asthma symptoms - underutilized [5] - antibiotics generally not indicated - common clinical signs & symptoms do not identfy patients for whom antibiotic treatment is justified [1] - antibiotics are not indicated for acute rhinosinusitis [6] - antibiotics are not indicated even if symptoms persist for > 7-10 days [1] - antibiotics may be indicated for - symptoms lasting > 10 days + - severe symptom onset or - high fever + purulent nasal discharge or - facial pain lasting >= 3 days or - worsening symptoms after a viral illness that was improving [4] - treatment for acute baterial rhinosinusitis is amoxicillin clavulanate [7] - amoxicillin alone is less effective due to resistance of Haemophilus influenzae - endoscopic sinus surgery improves sleep & quality of life in patients with chronic rhinosinusitis

Specific

acute rhinosinusitis rhinosinusitis with nasal polyposis

General

rhinitis sinusitis

References

  1. Young J, De Sutter A, Merenstein D et al Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. 2008 Mar 15;371(9616):908-14. PMID: 18342685
  2. Dixon AE et al. Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma. J Allergy Clin Immunol 2015 Mar; 135:701. PMID: 25174863 http://www.jacionline.org/article/S0091-6749%2814%2900957-9/abstract - Greenberger PA. Will a nasal corticosteroid improve control for patients with step 3 or higher persistent asthma? J Allergy Clin Immunol 2015 Mar; 135:710. PMID: 25630938 http://www.jacionline.org/article/S0091-6749%2814%2903710-5/abstract
  3. Alt JA et al. Quality of life in patients with chronic rhinosinusitis and sleep dysfunction undergoing endoscopic sinus surgery: A pilot investigation of comorbid obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2015 Sep 10 PMID: 26356240
  4. Harris AM, Hicks LA, Qaseem A et al Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. Published online 19 January 2016 PMID: 26785402 http://annals.org/article.aspx?articleid=2481815
  5. Rudmik L, Xu Y, Liu M et al Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis. A Canadian Population-Based Analysis. JAMA Otolaryngol Head Neck Surg. August 25, 2016 PMID: 27560503 http://archotol.jamanetwork.com/article.aspx?articleid=2546533
  6. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
  7. NEJM Knowledge+ Allergy/Immunology
  8. Acute rhinosinusitis in Adults: Guidelines for Clinical Care University of Michigan Health System http://cme.med.umich.edu/pdf/guideline/rhino05.pdf