Clinical practice guideline: Adult sinusitis

Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, NY 11201-5514, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 1.72). 10/2007; 137(3 Suppl):S1-31. DOI: 10.1016/j.otohns.2007.06.726
Source: PubMed

ABSTRACT This guideline provides evidence-based recommendations on managing sinusitis, defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States, resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity, the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis, evaluated in any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis.
The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis, reduce inappropriate antibiotic use, reduce inappropriate use of radiographic imaging, and promote appropriate use of ancillary tests that include nasal endoscopy, computed tomography, and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology-head and neck surgery, pulmonology, and radiology.
The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain. The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected. The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures. The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) 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, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance for managing adults with rhinosinusitis. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

  • Source
    • "Consideration should be given to proper counselling of the patient about the possible adverse effect of medicines . Though Nepal does not provide systematic clinical practice guidelines for the treatment of specific medical conditions , the physician should adhere to the antibiotic dosing recommendations of international professional societies (Rosenfeld et al., 2007). Exceeding the daily recommended dose of antibiotics may lead to an adverse drug reaction, or worsen an existing reaction. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A 46-year-old female patient developed severe abdominal pain shortly after taking levofloxacin, 1000 mg for acute bacterial sinusitis. The pain started after taking the first dose of levofloxacin and became worse after the second dose. The patient was unable to do daily physical activities. The pain resolved upon discontinuation of levofloxacin and symptomatic therapy. Other factors that may cause abdominal pain were ruled out. This case is of interest as it documents severe abdominal pain due to levofloxacin requiring discontinuation of therapy and describes its appropriate management. In addition, it highlights the vital role that community pharmacists could play in managing adverse drug reactions (ADRs) and preventing potential Drug Related Problems (DRPs).
    Saudi Pharmaceutical Journal 07/2013; 21(3):323-5. DOI:10.1016/j.jsps.2013.04.006 · 1.00 Impact Factor
  • Source
    • "CRS was diagnosed by two different otolaryngologists using endoscopic examination and nasal CT scanning , according to the following definition: 12 weeks or longer of two or more of the following symptoms: mucopurulent drainage, nasal obstruction, facial pain-pressure-fullness, or decreased sense of smell; and findings of purulent mucus or edema in the middle meatus or ethmoid region, polyps in the nasal cavity or the middle meatus, and/or radiographic imaging showing inflammation of the paranasal sinuses [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: IgG4-related disease involves nasal manifestations with chronic rhinosinusitis (CRS). This type of sinusitis is a new clinical entity of nasal disease associated with a high level of serum IgG4 for which steroid therapy is effective. Objectives. To confirm whether IgG4-related disease has distinctive chronic rhinosinusitis. We compared serum IgG4 levels as well as nasal computed tomography (CT) and clinicopathological findings before and after glucocorticoid treatment in 31 patients diagnosed as having IgG4-related disease with nasal manifestations. To evaluate immunohistochemical findings of nasal mucosa, we compared them with IgG4-related CRS and common CRS. All patients had levels of high serum IgG4. Ten of the 31 patients had nasal obstruction, nasal discharge, postnasal discharge, hyposmia, and dull headache. They also demonstrated sinus lesions on radiological findings. After glucocorticoid treatment, serum IgG and IgG4 levels were markedly decreased and along with improvement of the symptoms, nasal sinus CT findings also revealed improvement of the sinus opacification. In immunohistochemical examination, the magnitude of IgG4-positive plasma cell infiltration in common CRS was almost the same as in the IgG4-related CRS group. Therefore, in nasal mucosa immunocytochemical positive staining for IgG4 is not specific for definition of IgG4-related disease.
    Acta oto-laryngologica 05/2011; 131(5):518-26. DOI:10.3109/00016489.2010.533699 · 0.99 Impact Factor
  • Source
    • "This is, however, only an indication and not conclusive evidence of a bacterial origin for acute bacterial rhinosinusitis. Imaging, laboratory tests or bacterial culture are not recommended for routine use in primary care (Hickner et al 2001, Rosenfeld et al 2007a). The primary care clinician is thus left to base the diagnosis of acute bacterial rhinosinusitis on signs and symptoms seen in the clinic in line with the procedures used in this study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Is there any difference between the effect of therapeutic ultrasound and antibiotics (amoxicillin) on pain and congestion for acute bacterial rhinosinusitis in the short-term? Is there any difference in patient satisfaction, preferred future intervention, side-effects and relapses in the long-term? A randomised trial with concealed allocation and intention-to-treat analysis. 48 patients (6 dropouts) with clinically diagnosed acute bacterial rhinosinusitis in primary care. Intervention: The experimental group received 4 consecutive days of ultrasound and the control group received a 10-day course of antibiotics. Pain and congestion around the nose and in the forehead and teeth were measured on a 0-10 numeric rating scale at baseline, Day 4, and Day 21. Satisfaction, preferred future intervention, side-effects, and relapses were measured one year later. By Day 4, pain around the nose had decreased by 1.5 points out of 10 (95% CI 0.6 to 2.5) more in the experimental group than the control group. There were no other differences in decrease in pain and congestion between the groups at Day 4 or 21. At one year follow-up, the experimental group were more likely to prefer ultrasound than the control group were to prefer antibiotics to manage a future episode (RR 2.75, 95% CI 1.19 to 7.91). There were no other differences between the groups in terms of satisfaction with intervention, number of side-effects, or number of relapses. The results of this study suggest that therapeutic ultrasound is a viable alternative to antibiotics in the management of acute bacterial rhinosinusitis. NCT00934830.
    Journal of physiotherapy 12/2010; 56(1):29-32. DOI:10.1016/S1836-9553(10)70051-5 · 2.89 Impact Factor
Show more