Diagnosis Of Acute Rhinosinusitis Research Articles

Diagnostic prediction models for CT-confirmed and bacterial rhinosinusitis in primary care: individual participant data meta-analysis.

BackgroundAntibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment.AimTo develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS.Design and settingThis was a systematic review and individual participant data meta-analysis.MethodCT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling.ResultsAmong 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimism-corrected c-statistic of 0.73 (95% confidence interval [CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95% CI = 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95% CI = 0.63 to 0.77) and a calibration slope of 1.00 (95% CI = 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition.ConclusionSimple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.

Akutni rinosinuzitis - patogeneza, dijagnostika i lečenje

Acute rhinosinusitis (ARS) is an inflammation of the mucous membranes of the nasal cavity and paranasal sinuses with symptoms lasting up to 12 weeks. In more than 98% cases, ARS begins as a viral infection with common cold symptoms, usually caused by rhinoviruses or more severe acute viral rhinosinusitis usually caused by coronaviruses, influenza and parainfluenza virus. Worsening of symptoms after 5 days or persistence of symptoms after 10 days indicate the diagnosis of acute postviral rhinosinusitis, which indicates the presence of bacterial superinfection on the basis of previous viral infection. In about 0,5-2% of cases, complications of ARS with bacterial infection occur, so we have a clinical history of acute bacterial rhinosinusitis (ABRS). The most common causes of ABRS are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Diagnosis and treatment of uncomplicated ARS are the responsibility of primary care physicians. Failure in treatment indicates a potential complication of the disease, when the patient needs to be referred by an otorhinolaryngology specialist. The first line of the antimicrobial treatment of ARS is the use of amoxicillin. Inadequate response to firstline antimicrobial therapy within the 72 hours indicates the need for some broad-spectrum antibiotics. Complementary therapy consists of the use of saline solutions for rinsing the nasal cavity, decongestants in the form of drops, sprays or tablets, herbal drugs, as well as intranasal corticosteroids in the form of sprays.

The application of ultrasound examination in the treatment of Acute Sinusitis. Comparing X-ray to ultrasound of paranasal sinuses

Background: Acute rhinosinusitis (ARS) is one of the most common diseases encountered in the out-patient setting. X-ray of the paranasal sinuses is the gold standard in the diagnosis of ARS with its accessibility and accuracy. Ultrasound examination of the paranasal sinuses is a noninvasive diagnostic method which is an acceptable alternative in the follow-up of the treatment. Aim: To present the application of portable sinuson in the out-patient setting on patients with ARS and its effectiveness. Materials and Methods: 22 patients (12m/10f) underwent X-ray of the paranasal sinuses, which resulted in ARS. The results of the X-rays were compared with the ultrasound examination of the paranasal sinuses with a portable sinuson (SINUSULTRA ULTRAMAX). The examination was repeated on the 1-st and 2-nd week and 2 months after the treatment for ARS. Results: From the 22 patients – 10 were with unilateral maxillary sinusitis, 7 with bilateral sinusitis and 5 with pansinusitis. 5 (22%) false positives were registered from the ultrasound examination on the initial check-up, 3 (13%) false negatives were registered on the follow-ups on the 1-st and the 2-nd week, 2 (9%) false negatives were registered 2 months after the treatment for ARS. Conclusion: Ultrasound examination of the paranasal sinuses is a noninvasive, painless, fast and with an adequate degree of accuracy. It is a good alternative for children and pregnant women. Ultrasound examination can be applied in the follow-up of ARS.

Phototherapy is a pathogenetic method in the treatment of acute sinusitis

Currently, physical treatment methods, in particular use of photochromotherapy in the treatment of sinusitis, are of interest. Is to investigate the local effect of light in the visible range (450 nm) on the factors of local infection protection of the nasal mucosa. The study involved 50 patients with a diagnosis of acute rhinosinusitis at the age of 27.23±3.29 years. Exposure of the mucous membrane of the nasal cavity was carried out in accordance with the parameters: 450 nm wavelength (monochromatic non-polarized blue light), during 5 minutes for each nostril. Sessions of photochromotherapy were carried out according to the "Sanitary norms and rules for the design and operation of lasers" No. 5804-91. Inclusion of photochromotherapy in the complex of therapeutic measures for patients with acute rhinosinusitis helps to reduce the total number of neutrophils in nasal secretion, normalize their lysosomal activity, NBT-reducing activity, activity and intensity of phagocytosis. Restoration of local immunity factors in nasal mucosa, expressed in normalizing the functional and metabolic status of neutrophil granulocytes of the nasal secretion, can serve as one of the criteria for the effectiveness of treatment using photochromotherapy

Diagnostic Dilemma of Sinus Headache and Migraine

This review article aims to clarify and elucidate how to diagnose correctly sinus headache by discussing sinus headache as regards to its epidemiology, clinical picture, radiological investigations, as well as its medical and endoscopic management. The article also will clarify the relationship between a sinus headache and other co-morbidities, namely migraine, facial pain, and allergy, and the differential diagnosis of sinus headache. That sinus headache is not indicating life-threatening health problem, not a common disease, and usually is overrated. Usually the patient and sometimes the physician will attribute the patient’s facial pain to a sinus headache, while in fact it is caused by another pathological condition. Sinus headache is better to be diagnosed by exclusion and to be confirmed by nasal endoscopy before rushing into its treatment. Although it is neither sensitive nor specific in cases of chronic rhinosinusinusitis, plain X-ray is beneficial in the diagnosis of acute rhinosinusitis. Computed tomography (CT) is recommended, but it is not conclusive and it is important to know that a CT scan may remain abnormal even after endoscopic sinus surgery. Magnetic resonance imaging (MRI) is excellent and it is the choice option wherever possible. Pharmaceutical treatment of sinus headache should be addressed first before adopting surgery option; and if functional endoscopic sinus surgery (FESS) is chosen, which is the most common type of surgery used, preoperative assessment is very important to reduce complications.

Trends in complications of pediatric rhinosinusitis in the United States from 2006 to 2016

Objectives1) Evaluate the changing prevalence of complications from pediatric acute bacterial rhinosinusitis and 2) elucidate factors associated with the development of complicated acute rhinosinusitis in this population. Study Design/SettingCross-sectional analyses of the Kids’ Inpatient Database. Subjects and methodsChildren <20 years with a diagnosis of acute rhinosinusitis were included. Diagnosis codes pertaining to acute rhinosinusitis-related complications were then queried for each subject. All patients were ultimately categorized into one of four groups: uncomplicated acute rhinosinusitis, orbital complications, intracranial complications, or both orbital and intracranial complications. Weighted measures were applied to provide national estimates. ResultsOver the decade studied, national estimates for children admitted with acute rhinosinusitis decreased from 8,312 cases in 2006 to 5,592 in 2016. There was an increase in the rate of orbital complications from 8.9% to 19.3% and intracranial complications from 2.2% to 4.3%. Children with both complications increased from 0.5% to 1.0% of cases. Children with orbital complications were significantly younger (8.6 years) compared to those with intracranial complications (12.4 years) and both complication types (12.2 years) (p < 0.001). ConclusionDespite an overall decrease in cases of acute rhinosinusitis, rates of orbital and intracranial complications continued to increase over a ten-year period. Antibiotic prescribing patterns, vaccination effects, and evolving practice patterns may help explain these observations. Further studies warrant investigation into the cause of these trends. Level of evidence4.

Acute rhinosinusitis among pediatric patients with allergic rhinitis: A nationwide, population-based cohort study.

BackgroundWhile chronic rhinosinusitis is a common complication of allergic rhinitis, the link between acute rhinosinusitis and allergic rhinitis is unclear. The aim of this study was to evaluate the risk of incident acute rhinosinusitis among pediatric patients with allergic rhinitis, using a nationwide, population-based health claims research database.MethodsNewly diagnosed allergic rhinitis patients aged 5–18 years were identified from the health claim records of the Longitudinal Health Insurance Database 2000 of Taiwan’s National Health Insurance Research Database. A comparison cohort was assembled by randomly selecting patients from the same database with frequency matching by sex, age group, and index year. All patients were followed until a diagnosis of acute rhinosinusitis or the end of the follow-up period. Cox proportional hazards model was used to assess the association between allergic rhinitis and acute rhinosinusitis.ResultsOf the 43,588 pediatric patients included in this study, 55.4% were male and 43.9% were between the ages of 5.0–7.9 years. The risk of acute rhinosinusitis was significantly higher in pediatric patients with allergic rhinitis compared to those without the condition (adjusted hazard ratio = 3.03, 95% confidence interval = 2.89–3.18). Similar hazard ratios were observed between male and female pediatric patients.ConclusionsThis secondary cohort study using a nationwide, population-based health claim data of the Taiwan’s NHIRD showed that allergic rhinitis was significantly associated with a higher risk of acute rhinosinusitis among pediatric patients.

A pathway to value-based care of chronic rhinosinusitis using a claims database.

ObjectiveTo construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients.Study DesignHistorical cohort study utilizing private and public payer databases.MethodsMedical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed.ResultsThere were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post‐ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on.ConclusionsThis data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described “value proposition” for the surgical management of those CRS patients refractory to medical management.Level of Evidence4

Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review.

(1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS. Data Sources: PubMed and Embase. Review Methods: A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS. The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [ P = .96]; 8.1 vs 8.2 days [95% confidence interval -0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts. The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.

Antibiotics for acute rhinosinusitis in adults.

Acute rhinosinusitis is an acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of acute rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.We merged two Cochrane Reviews for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. To assess the effects of antibiotics versus placebo or no treatment in adults with acute rhinosinusitis in ambulatory care settings. We searched CENTRAL (2017, Issue 12), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1950 to January 2018), Embase (January 1974 to January 2018), and two trials registers (January 2018). We also checked references from identified trials, systematic reviews, and relevant guidelines. Randomised controlled trials of antibiotics versus placebo or no treatment in people with rhinosinusitis-like signs or symptoms or sinusitis confirmed by imaging. Two review authors independently extracted data about cure and side effects and assessed the risk of bias. We contacted trial authors for additional information as required. We included 15 trials involving 3057 participants. Of the 15 included trials, 10 appeared in our 2012 review, and five (631 participants) are legacy trials from merging two reviews. No new studies were included from searches for this update. Overall, risk of bias was low. Without antibiotics, 46% of participants with rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Antibiotics can shorten time to cure, but only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; I² = 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; I² = 0%; 3 trials; moderate-quality evidence). Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial; moderate-quality evidence). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; I² = 0%; 3 trials; high-quality evidence). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; I² = 16%; 10 trials; high-quality evidence). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; I² = 21%; 12 trials; high-quality evidence). A disease-related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group). The potential benefit of antibiotics to treat acute rhinosinusitis diagnosed either clinically (low risk of bias, high-quality evidence) or confirmed by imaging (low to unclear risk of bias, moderate-quality evidence) is marginal and needs to be seen in the context of the risk of adverse effects. Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis. We could not draw conclusions about children, people with suppressed immune systems, and those with severe sinusitis, because these populations were not included in the available trials.

Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy.

Acute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta-analyses. To determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Systematic review of diagnostic tests in outpatient, primary care, and specialty settings. The authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta-analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. In general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.

Acute Rhinosinusitis: Prescription Patterns in a Real-World Setting.

Understand real-world prescription patterns for patients presenting with a first diagnosis of ARS and evaluate adherence to published medical guidelines. Retrospective administrative database analysis. US-based outpatient settings. From a US claims database (MarketScan), 99,033 patients were identified with acute rhinosinusitis (ARS) in 2012 ("index"), with a complete medical and prescription history for 12 months preindex and 18 months postindex and no diagnoses of asthma or chronic rhinosinusitis. Of these, a random 10,000-patient sample was generated matched for age and sex to the initial cohort. Prescriptions and procedures at index, as well as complications up to 12 months postindex, were analyzed. Nearly 90% of all patients received a prescription at index. Antibiotics were prescribed for 84.8% patients, followed by antitussives (16.2% for adults, 6.2% for pediatrics), nasal corticosteroids (15.5% adults, 7.5% for pediatrics), and systemic corticosteroids (10.3% for adults, 5.5% for pediatrics), with 49% adults and 29% children receiving >1 medication at first visit. Macrolides were the most frequently prescribed antibiotics (35.6% adults, 28.6% pediatrics), followed by amoxicillin/clavulanate and amoxicillin. Within 12 months of index, 3 patients presented with meningitis and 3 with orbital cellulitis. Significant variability in ARS treatment was observed, highlighting the need for heightened awareness of existing guidelines.

Endoscopic and histological staging: Deciding factors in the treatment of chronic rhinosinusitis

Abstract Chronic rhinosinusitis represents an inflammatory condition of the nose and paranasal sinuses, characterized by two or more symptoms. The diagnosis of acute rhinosinusitis is made, most often, clinically; however, in the case of chronic rhinosinusitis, imaging, bacteriological, as well as the histological investigation are necessary in order to establish the diagnosis and to exclude other diseases that have caused and/or are associated with rhinosinusitis. Different scores (clinical, imagistic) have been described over time, being considered as important factors in the therapeutic decision (surgical or conservative) in patients with chronic rhinosinusitis. The authors present their experience in using and relying on endoscopic and histological scores.

A Comparison of Cefditoren Pivoxil 8-12 mg/kg/day and Cefditoren Pivoxil 16-20 mg/kg/day in Treatment of Children With Acute Presumed Bacterial Rhinosinusitis: A Prospective, Randomized, Investigator-Blinded, Parallel-Group Study.

ObjectivesCefditoren pivoxil (CDT) has been used in the treatment of rhinosinusitis. However, little is known about the efficacy of this drug at low and high doses. This study was to compare the efficacy and safety of low dose (8-12 mg/kg/day) and high dose (16-20 mg/kg/day) CDT in the treatment of children with uncomplicated acute rhinosinusitis (ARS).MethodsThis investigation was a randomized, investigator-blinded, and parallel study, conducted in patients (aged 1-15 years) with a clinical diagnosis of uncomplicated ARS. Two groups of patients randomly received low dose or high dose CDT for 14 days. Patients' symptoms were assessed quantitatively using a quantitative symptom score (the S5 score). The changes in sinus symptoms and adverse events were provided by patients and their parents/caregivers. The response rate and adverse effects were evaluated at days 7 and 14. The relapse rate was recorded at days 21 and 28. The recurrences of sinus symptoms at day 60 were also assessed.ResultsOne hundred forty patients were recruited and randomized; 72 received low dose CDT (group I) and 68 received high dose CDT (group II). There were no significant differences in demographic data including sex, age, presenting symptoms, medical history, and X-ray findings between two groups. The responses rate at day 14 in groups I and II were 95.5% and 95.4%, respectively (P>0.99). There were no significant differences between groups in relapse rate at day 28 and no recurrence at day 60 in either group. The most common treatment-related adverse events were diarrhea (4.2% in group I vs. 2.9% in group II) and vomiting (2.8% in group I vs. 10.3% in group II). There was no statistically significant difference in adverse events between groups.ConclusionBoth low and high doses regimens of CDT appeared a similar clinical outcome for treatment in uncomplicated ARS in pediatric patients.

The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis.

To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS). Electronic databases were systematically searched for relevant studies published up to June 2012. Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%). Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.

HERBAL DRUGS IN PEDIATRIC RHINOSINUSITS TREATMENT

The article referred to the use of herbal drugs in treatment of acute rhinosinusitis in children. Topical aspects of the etiology, pathogenesis, clinical manifestations and diagnosis of acute rhinosinusitis in children are disscussed. The advantages of application of herbal drugs in such pathology are discussed indications for these drugs and possible side effects. The results of research of the efficacy and safety of herbal drugs for the treatment and prevention of acute sinusitis in children are adduced .

National burden of antibiotic use for adult rhinosinusitis

National burden of antibiotic use for adult rhinosinusitis

A prospective, controlled study of SNS01 (ectoine nasal spray) compared to BNO-101 (phytotherapeutic dragées) in patients with acute rhinosinusitis

Objectives:In this observational study, data on the efficacy, effects on quality of life and tolerability of the topical formulation SNS01 (Ectoin Rhinitis nasal spray) were compared to those of BNO-101 (Sinupret forte dragées) in patients with acute rhinosinusitis in the ear, nose, and throat (ENT) clinical setting.Design and methods:Patients with the diagnosis of acute rhinosinusitis were included in this non-interventional study with a treatment duration of 14–16 days. They received either a herbal phytotherapeutic dragée (control) or an ectoine-based nasal spray (investigational product), each to be taken according to the instructions for use (IFU) and summary of product characteristics (SPC). At each visit, the physician performed a nasal endoscopy, recorded the Sinusitis Symptom Score and checked for adverse events. During the entire treatment period, patients recorded the Sinusitis Symptom Score in patient diaries. In addition, patients receiving the nasal spray filled out a questionnaire to assess the tolerability of the treatment. To investigate effects on quality of life patients were asked to fill out the German version of a sinusitis-specific HRQL (health related quality of life) questionnaire.Clinical trial registration:NCT01684540.Results:Patient diary entries, the assessment of the Sinusitis Symptom Score and the HRQL questionnaire demonstrated that the ectoine nasal spray was as effective as the phytotherapeutic dragées in treating acute rhinosinusitis. After two weeks of treatment, the assessments of both the patients’ diaries and physicians’ record forms indicated statistically significant improvement (p ≤ 0.001) in the symptom scores of the two groups (57.8% improvement for ectoine and 49.3% improvement for the phytotherapeutic dragées compared to baseline). Also, overall scores of 80 in the sensory questionnaire confirmed the good tolerability of the nasal spray. Correspondingly, HRQL improved significantly over the course of the treatment in both groups.Conclusion:SNS01 and BNO-101 demonstrated comparable effects in the treatment of acute rhinosinusitis.Limitations:Following German regulations, this trial was set up as an observational ‘non-interventional’ study, which does not allow for a placebo group or randomization of patients. Although the grade of evidence delivered by the study data is thus reduced from Ib to IIa, it does, however, reflect a realistic view of the most common clinical practice.

Diagnosis of acute rhinosinusitis

Rhinosinusitis is almost always a complication of a viral infection involving the upper respiratory tract. A common cold is the first symptom of rhinosinusitis, but infectious processes involving the nose inevitably affect the paranasal sinuses because of their anatomical contiguity. The symptoms remain those of a common cold as long as nasal phlogosis is moderate and the ostia between the nose and sinuses are patent. If the inflammation is intense, edema may obliterate the ostia and isolate the sinuses, thus stopping the removal of the exudates. The duration of symptoms makes it possible to distinguish acute (10-30 days) from subacute (30-90 days) and chronic rhinosinusitis (>90 days). The diagnosis of rhinosinusitis should only be based on anamnestic and clinical criteria in children with serious or persistent symptoms of upper respiratory tract infection, or which appear within a short time of an apparent recovery. Computed tomography and magnetic resonance images of the paranasal sinuses should be reserved for children reasonably considered to be candidates for surgery. Antibiotics are recommended in cases of mild acute bacterial rhinosinusitis as a means of accelerating the resolution of symptoms. The use of antibiotics is mandatory in severe acute bacterial rhinosinusitis to cure the disease and avoid the possible onset of severe complications.

Management of acute rhinosinusitis

Acute rhinosinusitis (ARS) is one of the most common reasons for physician visits and for significant school absenteeism, although precise data on its prevalence and incidence are still lacking. RS is defined as acute if there are symptoms lasting <12 wk with complete resolution. Superinfection by bacteria following a viral infection is the most important mechanism of ARS. Diagnosis of ARS should be made on clinical grounds alone. Typically, acute bacterial RS is self-limited and goes through spontaneous recovery within 4 wk. Recognizing the occurrence of bacterial superinfections of the sinuses during a common viral respiratory infection is fundamental to making the decision to start an appropriate antibiotic treatment. Topical treatments such as saline irrigation, nasal decongestants, steroids, antihistamines, and fungicides are all in widespread pediatric use, but analyzing the literature gives poor evidence of efficacy, except for topical steroids. RS is a multifactorial condition that poses a diagnostic and management challenge to infectivologist and ear-nose-throat specialists as well as to pediatricians.