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American Family Physician Jul 2016Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory care. Most cases of acute rhinosinusitis are caused by viral upper... (Review)
Review
Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory care. Most cases of acute rhinosinusitis are caused by viral upper respiratory infections. A meta-analysis based on individual patient data found that common clinical signs and symptoms were not effective for identifying patients with rhinosinusitis who would benefit from antibiotics. C-reactive protein and erythrocyte sedimentation rate are somewhat useful tests for confirming acute bacterial maxillary sinusitis. Four signs and symptoms that significantly increase the likelihood of a bacterial cause when present are double sickening, purulent rhinorrhea, erythrocyte sedimentation rate greater than 10 mm per hour, and purulent secretion in the nasal cavity. Although cutoffs vary depending on the guideline, antibiotic therapy should be considered when rhinosinusitis symptoms fail to improve within seven to 10 days or if they worsen at any time. First-line antibiotics include amoxicillin with or without clavulanate. Current guidelines support watchful waiting within the first seven to 10 days after upper respiratory symptoms first appear. Evidence on the use of analgesics, intranasal corticosteroids, and saline nasal irrigation for the treatment of acute rhinosinusitis is poor. Nonetheless, these therapies may be used to treat symptoms within the first 10 days of upper respiratory infection. Radiography is not recommended in the evaluation of uncomplicated acute rhinosinusitis. For patients who do not respond to treatment, computed tomography of the sinuses without contrast media is helpful to evaluate for possible complications or anatomic abnormalities. Referral to an otolaryngologist is indicated when symptoms persist after maximal medical therapy and if any rare complications are suspected.
Topics: Acute Disease; Administration, Intranasal; Adrenal Cortex Hormones; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Blood Sedimentation; C-Reactive Protein; Humans; Maxillary Sinusitis; Nasal Lavage; Rhinitis; Sinusitis; Tomography, X-Ray Computed; Virus Diseases; Watchful Waiting
PubMed: 27419326
DOI: No ID Found -
International Forum of Allergy &... Feb 2016The body of knowledge regarding rhinosinusitis(RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those... (Review)
Review
BACKGROUND
The body of knowledge regarding rhinosinusitis(RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS).
METHODS
Evidence-based reviews with recommendations(EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR)was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus.
RESULTS
The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS)with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AECRS), and pediatric RS.
CONCLUSION
As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too often the foundation upon which these recommendations are based is comprised of lower level evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed.
Topics: Acute Disease; Child; Chronic Disease; Consensus; Evidence-Based Medicine; Humans; Nasal Polyps; Rhinitis; Sinusitis
PubMed: 26889651
DOI: 10.1002/alr.21695 -
RMD Open Feb 2024To determine whether antecedent sinusitis is associated with incident rheumatic disease.
OBJECTIVES
To determine whether antecedent sinusitis is associated with incident rheumatic disease.
METHODS
This population-based case-control study included all individuals meeting classification criteria for rheumatic diseases between 1995 and 2014. We matched three controls to each case on age, sex and length of prior electronic health record history. The primary exposure was presence of sinusitis, ascertained by diagnosis codes (positive predictive value 96%). We fit logistic regression models to estimate ORs for incident rheumatic diseases and disease groups, adjusted for confounders.
RESULTS
We identified 1729 incident rheumatic disease cases and 5187 matched controls (mean age 63, 67% women, median 14 years electronic health record history). After adjustment, preceding sinusitis was associated with increased risk of several rheumatic diseases, including antiphospholipid syndrome (OR 7.0, 95% CI 1.8 to 27), Sjögren's disease (OR 2.4, 95% CI 1.1 to 5.3), vasculitis (OR 1.4, 95% CI 1.1 to 1.9) and polymyalgia rheumatica (OR 1.4, 95% CI 1.0 to 2.0). Acute sinusitis was also associated with increased risk of seronegative rheumatoid arthritis (OR 1.8, 95% CI 1.1 to 3.1). Sinusitis was most associated with any rheumatic disease in the 5-10 years before disease onset (OR 1.7, 95% CI 1.3 to 2.3). Individuals with seven or more codes for sinusitis had the highest risk for rheumatic disease (OR 1.7, 95% CI 1.3 to 2.4). In addition, the association between sinusitis and incident rheumatic diseases showed the highest point estimates for never smokers (OR 1.7, 95% CI 1.3 to 2.2).
CONCLUSIONS
Preceding sinusitis is associated with increased incidence of rheumatic diseases, suggesting a possible role for sinus inflammation in their pathogenesis.
Topics: Humans; Female; Middle Aged; Male; Autoimmune Diseases; Case-Control Studies; Rheumatic Diseases; Arthritis, Rheumatoid; Sinusitis
PubMed: 38388169
DOI: 10.1136/rmdopen-2023-003622 -
Otolaryngology--head and Neck Surgery :... Apr 2022Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in...
OBJECTIVE
Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in recent sinusitis guidelines. The purpose of this systematic review was to describe epidemiological and clinical features, as well as management strategies of complicated ODS.
DATA SOURCES
PubMed, EMBASE, and Cochrane Library.
REVIEW METHODS
A systematic review was performed to describe various features of complicated ODS. All complicated ODS studies were included in qualitative analysis, but studies were only included in quantitative analysis if they reported specific patient-level data.
RESULTS
Of 1126 studies identified, 75 studies with 110 complicated ODS cases were included in qualitative analysis, and 47 studies with 62 orbital and intracranial complications were included in quantitative analyses. About 70% of complicated ODS cases were orbital complications. Only 23% of complicated ODS studies were published in otolaryngology journals. Regarding ODS-related orbital and intracranial complications, about 80% occurred in adults, and 75% were male. Complicated ODS occurred most commonly from apical periodontitis of maxillary molars. There were no relationships between sinusitis extent and orbital or intracranial complications. High rates of anaerobic and α-hemolytic streptococcal bacteria were identified in complicated ODS. Management generally included systemic antibiotics covering aerobic and anaerobic bacteria, and surgical interventions were generally performed to address both the complications (orbital and/or intracranial) and possible infectious sources (dentition and sinuses).
CONCLUSION
ODS should be considered in all patients with infectious extrasinus complications. Multidisciplinary management between otolaryngologists, dental specialists, ophthalmologists, and neurosurgeons should be considered to optimize outcomes.
Topics: Adult; Anti-Bacterial Agents; Humans; Male; Orbital Diseases; Otolaryngologists; Otolaryngology; Paranasal Sinuses; Sinusitis
PubMed: 34253072
DOI: 10.1177/01945998211026268 -
International Forum of Allergy &... Jun 2023Primary immunodeficiency disorders (PIDDs) may be a risk factor for development of recurrent acute rhinosinusitis (RARS). There are currently no clear guidelines for the... (Review)
Review
BACKGROUND
Primary immunodeficiency disorders (PIDDs) may be a risk factor for development of recurrent acute rhinosinusitis (RARS). There are currently no clear guidelines for the timing and methodology of PIDD testing in patients with RARS. The aim of this scoping review is to identify and analyze existing literature on this topic.
METHODS
A scoping review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Articles addressing recurrent acute sinusitis and immunodeficiencies were collected from PubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and systematically evaluated for eligibility by two reviewers.
RESULTS
Of the 209 unique articles identified, 11 met criteria for review and analysis. Articles consisted of historical cohort, case-control, and cross-sectional studies, in addition to case series and nonsystematic reviews. The majority (10) recommended immunodeficiency testing, consisting of general immunologic screening (3), quantitative immunoglobulins (6), and postvaccination antibody titers (5). There was an emphasis on immunoglobulin G (IgG) subclass testing (6). Of the eight articles providing timing recommendations, the majority recommended testing after recurrent infections or diagnosis (6); however, criteria for diagnosis of RARS and populations targeted by recommendations varied greatly by article.
CONCLUSION
Current literature on RARS emphasizes immunoglobulin quantification and postvaccination antibody titers to evaluate for PIDD after diagnosis, but recommendations are limited by wide-ranging populations of interest and inconsistent definitions. This scoping review identified a lack of evidence-based articles specific to diagnostic workup for PIDD in patients with RARS, and additional research with standardized definitions and focus on RARS is necessary to guide clinical practice.
Topics: Humans; Cross-Sectional Studies; Sinusitis; Immunologic Deficiency Syndromes; Acute Disease; Risk Factors
PubMed: 36355381
DOI: 10.1002/alr.23106 -
The Laryngoscope Sep 2014
Review
Topics: Acute Disease; Anti-Bacterial Agents; Humans; Sinusitis
PubMed: 24431223
DOI: 10.1002/lary.24540 -
The Journal of Laryngology and Otology Dec 2022To determine risk factors affecting mortality in acute invasive fungal sinusitis. (Observational Study)
Observational Study
OBJECTIVE
To determine risk factors affecting mortality in acute invasive fungal sinusitis.
METHOD
This observational cohort study was conducted over a five-year period.
RESULTS
Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex ( = 0.022), less than two weeks between symptoms and first intervention ( = 0.01), and intracranial involvement ( = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling ( = 0.016), restricted ocular movements ( = 0.053), intracranial symptoms ( = 0.008), posterior disease ( = 0.058), imaging showing ocular involvement ( = 0.041), fungus being zygomycetes ( = 0.050) and post-operative cavity infection ( = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis.
CONCLUSION
Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality.
Topics: Humans; Female; Sinusitis; Invasive Fungal Infections; Paranasal Sinuses; Risk Factors; Biopsy; Antifungal Agents
PubMed: 35292128
DOI: 10.1017/S0022215122000755 -
Seminars in Arthritis and Rheumatism Feb 2022To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA).
OBJECTIVE
To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA).
METHODS
This case-control study using the Mass General Brigham Biobank matched incident RA cases, confirmed by ACR/EULAR criteria, with at least seven years preceding electronic health record (EHR) data to three controls on age, sex, and EHR history from RA diagnosis (index date). We ascertained timing (>0-5 years/>5-10 years/>10 years) of the first documented respiratory tract disease prior to index date using diagnosis codes. We estimated odds ratios (OR) with 95% confidence intervals (CI) for RA for each respiratory exposure using logistic regression models, adjusting for potential confounders. We also conducted a stratified analysis by serostatus and smoking.
RESULTS
We identified 625 incident RA cases (median 56 years, 75% female, 57% seropositive) and 1,875 controls. Acute sinusitis was associated with RA only in the >5 to 10 years before RA (OR 3.90, 95% CI:1.90,8.01). In contrast, pneumonia was associated with RA only in the >0 to 5 years before RA (OR 1.73, 95% CI:1.00,3.00), and chronic respiratory tract diseases only >10 years before RA (OR 1.43, 95% CI:1.00,2.05). All respiratory tract diseases tended to show a stronger association with seronegative RA than seropositive RA, although the interaction was statistically significant only for chronic sinusitis (p=0.04). Respiratory diseases showed a nonsignificantly stronger association among smokers than nonsmokers.
CONCLUSION
Sinusitis and other respiratory diseases are associated with increased risk of RA, especially 5 years before RA onset. RA may begin many years before clinical onset.
Topics: Arthritis, Rheumatoid; Case-Control Studies; Female; Humans; Incidence; Male; Risk Factors; Sinusitis; Smoking
PubMed: 35042150
DOI: 10.1016/j.semarthrit.2021.11.008 -
Pharmacoepidemiology and Drug Safety Aug 2023Acute bacterial sinusitis is among the most frequent outpatient infections in children and adolescents and is well suited to study in large healthcare utilization...
PURPOSE
Acute bacterial sinusitis is among the most frequent outpatient infections in children and adolescents and is well suited to study in large healthcare utilization databases, but the validity of International Classification of Diseases, 10th Revision (ICD-10) codes together with antibiotic prescriptions to identify cases of acute bacterial sinusitis has not been established. We aimed to evaluate the validity of ICD-10 codes combined with antibiotic prescriptions to identify new diagnoses of acute bacterial sinusitis among pediatric patients evaluated in the outpatient setting.
METHODS
Children and adolescents aged 17 years and younger with an outpatient diagnosis of acute sinusitis along with an antibiotic prescription from an ambulatory facility affiliated with the Mass General Brigham health system were identified via a clinical data warehouse. Patients were stratified by age (0-5 years, 6-11 years, and 12-17 years), and 50 cases per age group were randomly sampled. Medical records were independently reviewed by two pediatric infectious diseases physicians to assess for the documentation of a clinician-defined diagnosis of acute bacterial sinusitis. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated.
RESULTS
A total of 150 patients were included in the final cohort. Frontal, maxillary, and "unspecified" sinuses accounted for 88% of the diagnoses. The positive predictive value of the algorithm to identify clinician-defined diagnoses of acute bacterial sinusitis was 92% (95% CI 87%, 95%). The PPVs were consistent across age strata.
CONCLUSIONS
ICD-10 codes for acute sinusitis, when paired with a same-day antibiotic prescription, have a high positive predictive value among a cohort of pediatric patients, suggesting that they can be used to study new acute bacterial sinusitis diagnoses with claims.
Topics: Adolescent; Humans; Child; Middle Aged; Outpatients; Sinusitis; Medical Records; Predictive Value of Tests; Anti-Bacterial Agents; Bacterial Infections; Acute Disease; International Classification of Diseases; Databases, Factual
PubMed: 36939079
DOI: 10.1002/pds.5617 -
European Review For Medical and... Dec 2022Rhinosinusitis is one of the most common diseases today. Among diseases requiring treatment with antibiotics, it is the fifth most common. Acute rhinosinusitis is a... (Review)
Review
Rhinosinusitis is one of the most common diseases today. Among diseases requiring treatment with antibiotics, it is the fifth most common. Acute rhinosinusitis is a significant medical problem that can significantly lower quality of life and can cause a large economic impact on society. Herein, we collected and analyzed data from several published studies regarding sinusitis with the aim of creating a sinusitis model. We included data from 786 studies published between 1996 and 2016 that came up on Google, Pro Quest Central or PubMed using the following keywords (or combinations thereof): "sinusitis", "rhinosinusitis", "experimental", "animal", "model", "rat", "rabbit", "guinea pig" and "mice". An appropriate sinusitis model must be established using the correct animal. Thus far, sinusitis models have been published in rats, mice, and rabbits, with rabbits being the most frequently used animal. These animals are used because the anatomy and physiology of their sinuses are very similar to those of humans. While these animals can be used in surgical models, it must be noted that prolonged stress can cause them high mortality rates. Several studies have used strains of Streptococcus pneumoniae to induce rhinosinusitis; however, it has recently been shown that other pathogenic agents can be used for this purpose as well. In this review, we presented several experimental sinusitis models in rats, mice, and rabbits. We hope that by presenting these methods, researchers may be better able to design and perform more useful sinusitis studies.
Topics: Humans; Rabbits; Mice; Rats; Guinea Pigs; Animals; Rhinitis; Consensus; Quality of Life; Sinusitis; Acute Disease; Allergens; Chronic Disease
PubMed: 36524916
DOI: 10.26355/eurrev_202212_30491