Clinical Diagnosis Of Acute Sinusitis Research Articles

Are Nasopharyngeal Cultures Useful in Diagnosis of Acute Bacterial Sinusitis in Children?

The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs). Nasopharyngeal swabs were collected from 204 children meeting a priori clinical criteria for acute sinusitis. All children had sinus X-rays at the time of diagnosis. To determine if negative nasopharyngeal culture results could reliably identify the subgroup of children with normal radiographs, we calculated negative predictive values and negative likelihood ratios. Absence of pathogens in the nasopharynx was not helpful in identifying this low-risk subgroup.

Paediatric pre- and post-septal peri-orbital infections are different diseases: A retrospective review of 262 cases

Peri-orbital infections can be classified as pre-septal or post-septal depending upon the location of the focus of infection. The ability to differentiate between these two is frequently difficult at the initial presentation, with marked orbital edema and pain limiting the ophthalmic examination. Hence, it is important to identify all the features at presentation that will lead to an accurate and rapid diagnosis and treatment. Our retrospective review of peri-orbital infections identifies contrasting features between these two groups that will aid the clinician in the subsequent management of these infections. A retrospective review over an 11-year period of children admitted to a tertiary children's hospital for the treatment of peri-orbital cellulitis was undertaken. The two subgroups were identified, those suffering from a pre-septal infection and those with a post-septal infection. The groups were compared with respect to their presentation, clinical findings, findings on CT and surgical intervention. Two hundred and sixty-two children were identified with peri-orbital infections, 227 pre-septal, and 35 post-septal. There were statistically significant differences between the pre- and post-septal groups with regards to the following: age (3.9 vs. 7.5 years, p<0.001), medical co-morbidities (19% vs. 0%, p<0.01), a history of trauma (40% vs. 11% of cases, p<0.003), clinical diagnosis of acute sinusitis (9% vs. 91% of cases, p<0.001), and fever (47% vs. 94%, p<0.001). Ophthalmologic examination identified diplopia (p<0.001), opthalmoplegia (p<0.001) and proptosis (p<0.001) as significant features of a post-septal infection. Intravenous antibiotics were successful in treating the majority of cases, with 5% of pre-septal, and 25% of post-septal infections requiring surgery. When considering the management of a child with a peri-orbital infection, features from the history and examination such as trauma, medical co-morbidities and ophthalmic signs will guide management and delineate the indications for early CT imaging. In the absence of acute visual compromise or other signs of disease progression, initial management with intravenous antibiotics for 48 h to cover Staphylococcal aureus and Streptococcal pyogenes with nasal decongestant should be considered before surgical intervention is contemplated. A multi team approach is essential in obtaining the best outcome for the child.

Bacteriological findings in nasopharynx specimens from patients with a clinical diagnosis of acute sinusitis

Objective - To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. Design - Prospective study. Setting - Patients from general practice in Vestfold county, Norway. Patients - 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. Main outcome measures - Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. Results - In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. Conclusion - Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group.

Ultrasonography versus radiography in the diagnosis of maxillary sinusitis

Water's view plain film radiography was compared with ultrasonography in the diagnosis of acute maxillary sinusitis in 50 patients at the Radiology Department of King Hussein Medical Centre in Jordan with clinical diagnosis of acute sinusitis. Ultrasound showed 100% concordance with plain radiographs reported as showing complete opacifications or an air fluid level, the only reliable plain film indicator of an inflamed antrum. We conclude that ultrasonography, which is non-ionizing, can provide an alternative to plain radiography in the initial investigation of maxillary sinusitis.

Predictors of duration of acute sinusitis episodes treated with antibiotics

Objective - To evaluate which factors present at the onset of acute sinusitis predict the duration of illness among adult patients treated with antibiotics. Design - Cohort study with a 30-day follow-up. Setting - Norwegian general practice. Subjects - Eighty-six adult patients with a clinical diagnosis of acute sinusitis confirmed by Computed Tomography. Methods - Signs, symptoms and other variables present at the onset of treatment were dichotomized and analysed bivariately with duration of the sinusitis episode, using the log-rank test. Age, gender, and factors with p-values under 0.15 were modelled in a Cox regression analysis to assess independent predictors for illness duration. Main outcome measure - Duration of illness. Results - Illness duration was significantly and positively associated with increasing age and with a higher clinical severity score at the onset of treatment. No other factors were independent predictors of illness duration. Conclusion - The age of the patient and the clinical severity of the sinusitis at the onset of treatment were independent predictors of illness duration in adult patients treated with antibiotics.

Acute sinusitis in adults in Norwegian general practice: Incidence, complications, referral to ear-nose-throat specialist and economic costs

Objectives: To estimate the incidence of acute sinusitis among patients older than 14 years in Norwegian general practice. Furthermore, to register complications related to acute sinusitis, to assess the number of patients referred to an ENT specialist, and to estimate the costs that patients with acute sinusitis generate in the Norwegian health budget on a yearly basis.Methods: Adult patients with the clinical diagnosis of acute sinusitis seen in primary care in the municipality of Larvik were registered during a one-year period. During the winter of 1993, computed tomography (CT) was used as a reference standard to divide the patients into two groups; with and without confirmed sinusitis. Patients referred to the ENT specialist and his conclusions as to the differential diagnosis and prognosis were registered. The yearly cost of acute sinusitis was estimated by summating the costs of consultations, referrals, medication and sick leave.Results: During the one-year period, 1053 patients with 1138 episodes of acute sinusitis were clinically diagnosed, 69% women and 31% men. In the more detailed part of the study, 87 of the 138 patients (63%) had their clinical diagnoses confirmed by CT. The incidence of acute sinusitis was 21.7 episodes per 1000 adult inhabitants per year. 2% of the patients needed sinus puncture. Acute sinusitis generated an estimated cost of 192 million NOK per year, 75% of this was due to sick leave.Conclusions: The yearly incidence of acute sinusitis in Norway is similar to that of other countries, such as Denmark, the Netherlands, and the United Kingdom. Two thirds of the patients with sinusitis are women. Not many of these patients are referred to an ENT specialist. The disease has few complications. Acute sinusitis generates considerable national health care expenses, sick leave being a major part.

CT findings in general practice patients with suspected acute sinusitis.

To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation. Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis. One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative Ct. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70. The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.

Erythromycin and Phenoxymethylpenicillin (Penicillin V) in the Treatment of Respiratory Tract Infections as Related to Microbiological Findings and Serum C-reactive Protein

Respiratory tract pathogens (beta-haemolytic streptococci groups A, C and G, Haemophilus influenzae, Branhamella catarrhalis or pneumococci), were isolated from nasopharyngeal and/or throat swabs in 73/138 (53%) patients greater than 10 years of age with a clinical diagnosis of acute sinusitis, acute tonsillitis, purulent nasopharyngitis or acute bronchitis. Serological evidence of a viral infection (influenza A and B, parainfluenza 1, 2 and 3, respiratory syncytial virus, adenovirus) or Mycoplasma pneumoniae infection was found in 10% of the patients. The serum content of C-reactive protein (S-CRP) was increased (greater than 12 mg/l) in 26/33 (79%) patients with streptococci and in 22/59 (37%) patients without respiratory tract bacteria. In patients with a serological evidence of a virus tonsillitis, the S-CRP was also high (32-64 mg/l). At follow-up 10-12 days after the first visit, the clinical effect of erythromycin and penicillin V was judged to be similar (90% clinical effect). Relapse or re-infection with group A streptococci were seen in 7 patients (4 on erythromycin, 3 on penicillin). In another 6 patients (3 on erythromycin, 3 on penicillin), antibiotic treatment was switched owing to persisting symptoms, probably due to H. Influenzae infection in 3 cases. The patients' own estimates of their symptoms suggested treatment with erythromycin to have a more rapid effect than treatment with penicillin.