Management Of Acute Sinusitis Research Articles

Acute sinusitis in daily clinical practice.

Understanding the appropriate use of diagnostics and treatment in acute rhinosinusitis is of immense importance given the high prevalence of this disease in the general population. The ability to differentiate between the principal phenotypes of acute sinusitis, namely acute viral infection (cold), acute post-viral sinusitis and acute bacterial sinusitis, determines the future management and is fundamental to providing rational therapeutic recommendations - especially as regards antibiotic treatment, which is very often overused in acute sinusitis even though bacterial phenotypes only account for 0.5-2% of all cases of the disease. The latest therapeutic recommendations contained in the EPOS2020 position paper introduce a system based on integrated care pathways (ICPs), which comprise pharmacy-supported self-care and e-health as the first level, followed by primary care as the second, with specialist care being reserved for patients who develop a more severe course of the disease, have suspected complications or suffer from recurrent acute sinusitis. Management of acute sinusitis is primarily based on symptomatic treatment modalities, with phytotherapeutic support, as well as on antiinflammatory treatment, while antibiotic therapy is used in very specific and limited indications. Complications are relatively rare in acute sinusitis and they are not considered to be associated with antibiotic intake. Considering the high prevalence of acute forms of sinusitis, their significant impact on quality of life and high direct and indirect costs of treatment, the right diagnosis and management, without unnecessary escalation of therapy, can substantially translate into a number of public health benefits.

Infectious diseases in perspective.

Infectious diseases represent an ever-changing field of practice. Virtually each week brings new information, some with the potential to adjust or reinvent the current clinical practice. It is our task as clinicians to browse through field literature, through reports of randomized controlled trials, excerpts of conference proceedings, and to choose relevant scoops with high applicability in patient management. This supplement brings together four articles relevant to four different areas of medical practice, from HIV infection to Gram-negative bacilli such as Acinetobacter baumannii and Pseudomonas aeruginosa, and interdisciplinary studies on infectious acute maxillary sinusitis. Non-infectious comorbidities are of utmost importance in the management of HIV infection, as occurrence of kidney impairment, or fractures following decrease in bone mineral density, can significantly impact the quality of life and/or even life expectancy. The study presented at the 11th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” describes the epidemiology of chronic kidney disease and bone demineralization in HIV-positive patients from the Romanian HIV cohort, patients who acquired HIV infection at an early age, in infancy and childhood, in the late ‘80s, and who have since have tried all available therapeutic options. The prevalence of chronic kidney diseases is reported at 29.6 % for stage 2 and 1.4 % for stage 3 chronic kidney disease. The prevalence of lumbar osteopenia and osteoporosis was 33.3 % and 13.7 %, respectively, and that of femoral osteopenia and osteoporosis was 37.3 % and 7.8 %, respectively. An in-depth study of the virulence factors expressed by Pseudomonas aeruginosa revealed that virulence genes are highly prevalent in strains isolated from patients treated in a Dermatology department in Bucharest, Romania, namely ExoT (100 %), AlgD (92.3 %), genes codifying for phospholipases (84.6 % each) and genes coding for protease IV (61.5 %). A study performed by oromaxillofacial and dentoalveolar surgeons revealed an incidence of 4.3 % acute maxillary sinusitis in patients undergoing sinus lift procedures, and identified certain grafting materials which may be correlated with higher incidences. This study can pave the way for new therapeutic guidelines for the interdisciplinary management of acute sinusitis, which is currently treated by dental surgeons, ear-nose-throat practitioners, and infectious diseases specialists, alike. The last study included in the volume evaluated the patterns of antimicrobial susceptibility of Acinetobacter baumannii strains isolated from patients in intensive care, and reported a worrisome prevalence of carbapenem resistance: 94.6 % to imipenem and 86.5 % to meropenem. The authors conclude that there is dire need for new therapeutic options, as carbapenems are considered last-resort antibiotics, and the only antimicrobial to which Acinetobacter strains still displayed satisfactory susceptibility was colistin, with resistance reported in 9/37 strains (24.3 %) in this study.

Chronic sinusitis in children

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the bacterial pathogens causing disease, pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. It is apparent that anaerobic bacteria play a major role in this infection thereby influencing the natural history of disease and directing, to a great degree, medical management.

Acute Bacterial Sinusitis in Children

Sponsoring Organization: American Academy of Pediatrics Purpose and Objective: Update of 2001 recommendations for diagnosis and management of acute sinusitis in children between ages 1 and 18 years. Diagnosis:

Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children

Nasal irrigation has been used as adjunctive therapy for sinonasal disease but is under-researched in children. The study aim was to evaluate the effectiveness of nasal irrigation with normal saline in the management of acute sinusitis in atopic children. We enrolled 60 atopic children with acute sinusitis, of whom 29 received nasal irrigation with normal saline and 31 did not receive nasal irrigation. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, a nasal smear examination, and radiography (Water's projection) and were requested to complete a Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ) during the baseline visit. All participants were requested to record symptoms in a daily diary and were followed up at 1-week intervals. A physical examination, nasal smear, and nPEFR were performed at each visit, and all daily diaries were collected. At the final visit (after 3 weeks), the symptom diaries were reviewed and participants were requested to complete the PRQLQ again. nPEFR, radiography, and a nasal smear were also repeated. There were significant improvements in mean PRQLQ and nPEFR values (p < 0.05) for the irrigation compared to the non-irrigation group. There was no significant difference in radiographic findings between the groups (p > 0.05). The irrigation group recorded significant improvements in eye congestion, rhinorrhea, nasal itching, sneezing, and cough symptoms compared with the non-irrigation group. Nasal irrigation is an effective adjunctive treatment for acute sinusitis in atopic children.

Acute sinusitis: pitfalls in diagnosis and management

Acute sinusitis is one of the most common conditions that can present to a wide variety of clinicians ranging from general practitioners, Accident and Emergency, physicians, ophthalmologists and otolaryngologists to intensivists and even neurosurgeons. Delayed diagnosis with failure to recognize and manage (albeit rare) complications can be devastating for patients, potentially resulting in blindness or even death. Management of the condition itself can lead to complications. This article reviews the current guidelines for diagnosis and management of acute sinusitis with emphasis on medicolegal aspects. Adverse events affecting patients with acute sinusitis are also presented illustrating the challenges in the assessment and management of this condition.

Efficacy of nasal irrigation in the treatment of acute sinusitis in children

Background Nasal irrigation has been used as an adjunctive therapy of sinonasal disease including acute/chronic sinusitis and allergic rhinitis. Several published articles reported it also improves clinical sinus symptoms. Objective To evaluate the effectiveness of normal saline nasal irrigation in the management of acute sinusitis in children. Design This was a randomized, prospective placebo-controlled study. Methods We included 69 participants with acute sinusitis. 30 of 69 participants underwent normal saline nasal irrigation. 39 of 69 participants were not receiving nasal irrigation. All participants performed nasal peak expiratory flow rate (nPEFR) test, nasal smear examination, radiography (Water's projection) and requested to complete the Pediatric Rhinoconjunctivitis Quality of Life Questionnaires (PRQLQ) at the baseline visit. All participants were requested to record the symptom diary card every day and were followed-up every 1 week during this period. A physical examination, nasal smear and nPEFR were performed at each visit, and all daily diary cards collected. At the final visit, the symptoms diaries were reviewed and participants were requested to complete the PRQLQ again. The nPEFR, radiography (Water's projection) and nasal smear were also repeated. Results Normal saline irrigation group significantly improved mean PRQLQ values and nPEFR values at medium ( T = 2.816, P < 0.05) and final period ( T = 2.767, P < 0.05) compared with the other group. Although there were no statically significant improving rate of radiography (Water's projection) in among two groups ( T = 0.545, P > 0.05), but normal saline irrigation group was better than the other group. The improval rate of mean TSS in the irrigation group significantly improved all symptoms compared with the placebo group, in which rhinorrhea, nasal congestion, throat itching, cough and sleep quality improved. 27 of 66 (40.9%) participants with atopy, 16 of 27 (53.33%) participants underwent normal saline irrigation. Normal saline irrigation atopy group significantly improved rhinorrhea, nasal congestion, throat itching and sleep quality symptoms compared with non-irrigation atopy group. Normal saline irrigation atopy group significantly improved nPEFR values at final period ( Z = 2.53, P < 0.05). Conclusion This study evidence that normal saline nasal irrigation improves Pediatric Rhinoconjunctivitis Quality of Life and decreases acute sinusitis symptoms. Nasal irrigation is an effective adjunctive treatment for pediatric acute sinusitis. Normal saline nasal irrigation in atopy children also improves allergic-related symptoms. We may need larger, longer and extended study to assess the conclusion.

Diagnosis and Management of Acute Sinusitis by Pediatricians

Acute sinusitis is frequently diagnosed in young children, yet little is known regarding pediatrician practices surrounding its diagnosis and management. The purpose of this work was to describe how pediatricians diagnose and manage nonsevere acute sinusitis in otherwise healthy children < or =6 years of age. We used a mail survey administered from June to August 2007 to a national random sample of 750 general pediatricians from the American Medical Association Master File. RESULTS. The response rate was 45% (N = 271). Pediatricians reported first considering acute sinusitis at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35 (21%), and > or =36 (20%) months. Symptoms thought to be "very important" in the diagnosis of acute sinusitis included prolonged symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion (43%); 60% reported that symptom duration is more important than symptom combination. Symptom durations expected before considering the diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16 (38%), and > or =17 (6%) days. Fifty-eight percent reported using sinus computed tomography scans "occasionally" or more often in the diagnosis of acute sinusitis. Ninety-six percent reported treating acute sinusitis with an antibiotic "frequently" or "always." Fifty-three percent reported using contingency antibiotic prescriptions "occasionally" or more often for acute sinusitis. Adjuvants used "frequently" or "always" included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%). We found significant variation in the age at which pediatricians begin considering the diagnosis of nonsevere acute sinusitis in children. Most pediatricians consider symptom duration the most important diagnostic factor. The majority of pediatricians use sinus computed tomography imaging at least occasionally in young children with nonsevere symptoms despite its limitations in this clinical setting. Although poorly understood, the use of contingency antibiotic prescriptions is common. Lastly, the use of systemic decongestants and antihistamines in young children is reported, a practice that needs to be reexamined in light of recent Food and Drug Administration warnings regarding their safety.

Microbiology and antimicrobial management of sinusitis

Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while anaerobic bacteria and Staphylococcus aureus are predominant in chronic sinusitis. Pseudomonas aeruginosa has emerged as a potential pathogen in immunocompromised patients and in those who have nasal tubes or catheters, or are intubated. Many of these organisms recovered from sinusitis became resistant to penicillins either through the production of beta-lactamase (H. influenzae, M. catarrhalis, S. aureus, Fusobacterium spp., and Prevotella spp) or through changes in the penicillin-binding protein (S. pneumoniae). The pathogenicity of beta-lactamase-producing bacteria is expressed directly through their ability to cause infections, and indirectly through the production of betalactamase. The indirect pathogenicity is conveyed not only by surviving penicillin therapy, but also by 'shielding' penicillin-susceptible pathogens from the drug. The direct and indirect virulent characteristics of these bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections. The antimicrobials that are the most effective in management of acute sinusitis are amoxycillin-clavulanate (given in a high dose), the newer quinolones (gatifloxacin, moxifloxacin) and the second generation cephalosporins (cefuroxime, cefpodoxime, cefprozil or cefdinir). The antimicrobials that are the most effective in management of chronic sinusitis are amoxycillinclavulanate, clindamycin and the combination of metronidazole and a penicillin.

Sinusitis in Saudi Children

Sinusitis is considered one of the most common diseases in childhood, though no actual figures are quoted in the medical literature. This study, which was conducted in an ambulatory care facility a...

Diagnosis and Management of Acute Sinusitis

Diagnosis and Management of Acute Sinusitis

Diagnosis and management of acute sinusitis in children.

Diagnosis and management of acute sinusitis in children.