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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 Jun 2024The objective of this study was to analyze the trends and frequency in which recommended first-line therapy, amoxicillin with or without clavulanate, was prescribed for...
OBJECTIVE
The objective of this study was to analyze the trends and frequency in which recommended first-line therapy, amoxicillin with or without clavulanate, was prescribed for acute sinusitis based on current otolaryngology and other gold standard guidelines, as well as analyze differences in prescription behaviors of otolaryngologists compared with non-otolaryngologists for outpatient adult acute sinusitis visits.
METHODS
Weighted patient data from the National Ambulatory Medical Care Survey were analyzed to calculate visit rates and trends of antibiotic prescriptions for adults diagnosed with acute sinusitis from 2007 to 2019. Visits with multiple prescribed antibiotics or concomitant diagnoses requiring antibiotics were excluded. Each visit was classified based on the type of antibiotic prescribed.
RESULTS
Acute sinusitis was diagnosed in 0.63% of all outpatient visits from 2007 to 2019 (95% confidence interval: 0.56%-0.71%). Amoxicillin had the greatest increase in prescription frequency (13.4%), whereas macrolides had the largest decrease in prescription frequency (13.9%). Among adult acute sinusitis outpatient visits in which antibiotics were prescribed, recommended first-line antibiotic therapy of amoxicillin-clavulanate or amoxicillin alone was prescribed in 40.4% of visits. The most common antibiotic prescribed was amoxicillin-clavulanate at otolaryngologist visits (20.5%) and macrolides at non-otolaryngologist visits (26.0%). A greater proportion of otolaryngologist visits resulted in no antibiotics prescribed for acute sinusitis (36.8% vs. 22.5%, p < 0.001).
CONCLUSION
Otolaryngologists engage in watchful waiting more than non-otolaryngologists. Broader dissemination of existing guidelines for acute sinusitis treatment to non-Otolaryngologist (ENT) primary care specialties that take care of acute sinusitis to improve antibiotic stewardship and appropriate antibiotic selection is needed.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:2622-2625, 2024.
Topics: Humans; Sinusitis; Anti-Bacterial Agents; Adult; Acute Disease; Practice Patterns, Physicians'; Male; Female; Middle Aged; Ambulatory Care; Drug Prescriptions; United States; Amoxicillin; Health Care Surveys; Young Adult; Outpatients; Aged; Adolescent
PubMed: 38102927
DOI: 10.1002/lary.31227 -
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 -
The Journal of Craniofacial SurgeryAcute invasive fungal rhinosinusitis (mucormycosis) is a rare, highly fatal disease. This opportunistic fungal infection causes angioinvasion and ischemic tissue...
Acute invasive fungal rhinosinusitis (mucormycosis) is a rare, highly fatal disease. This opportunistic fungal infection causes angioinvasion and ischemic tissue necrosis. It mainly affects immunocompromised patients. Since the coronavirus disease 2019 (COVID-19) outbreak, many case reports have described the rhino-orbital-cerebral mucormycosis associated with COVID-19. However, the underlying predisposing factors are unknown. Several factors, other than diabetes, which is the most well-known contributing factor, may be involved in causing this severe fungal infection in COVID-19 patients. These factors may include steroid therapy, which is being used in severely dyspneic patients, the use of broad-spectrum antibiotics that may cause fungal flare-ups, and hospitalization with possible nosocomial infections. In addition, increased serum ferritin levels, possible endothelial damage, and pancreatic islets affection among COVID-19 patients may be implicated. Head and neck surgeons should be aware of the increasing prevalence of craniofacial mucormycosis among COVID-19 patients, as early diagnosis and prompt treatment are essential to improve the outcomes.
Topics: COVID-19; Humans; Mucormycosis; Orbital Diseases; SARS-CoV-2; Sinusitis
PubMed: 34560756
DOI: 10.1097/SCS.0000000000008231 -
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 -
International Forum of Allergy &... Feb 2022
Topics: Antifungal Agents; Humans; Invasive Fungal Infections; Sinusitis; United States
PubMed: 34569189
DOI: 10.1002/alr.22896 -
Clinical Infectious Diseases : An... Jul 2021Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in...
Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States.
BACKGROUND
Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development.
METHODS
We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules.
RESULTS
GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented.
CONCLUSIONS
An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Humans; Incidence; Infant; Otitis Media; Outpatients; Pharyngitis; Respiratory Tract Infections; Sinusitis; Streptococcus pyogenes; United States; Vaccination
PubMed: 32374829
DOI: 10.1093/cid/ciaa529 -
Vestnik Otorinolaringologii 2023Currently, the problem of acute rhinosinusitis continues to be relevant due to the frequent occurrence of this pathology. A certain difficulty is caused by the...
Currently, the problem of acute rhinosinusitis continues to be relevant due to the frequent occurrence of this pathology. A certain difficulty is caused by the differential diagnosis of viral, post-viral and bacterial forms of rhinosinusitis, which carries the risks of irrational therapy. The authors of the article discuss the role of a viral infection in the etiology and pathogenesis of acute rhinosinusitis, the stages in the development of an inflammatory reaction on the mucous membrane of the nose and paranasal sinuses, and the disruption of mucociliary clearance. The authors consider options for the pathogenetic therapy of postviral sinusitis, concluding that the use of local combined preparations containing the mucolytic acetylcysteine and the vasoconstrictor component of tuaminoheptane sulfate is effective.
Topics: Humans; Rhinitis; Sinusitis; Paranasal Sinuses; Nose; Diagnosis, Differential; Acute Disease
PubMed: 37450389
DOI: 10.17116/otorino20228803138 -
Vestnik Otorinolaringologii 2021Was to summarize data on the role and place of herbal remedies, in particular, the extract from the roots of (EPs 7630) in the treatment of acute sinusitis. (Review)
Review
THE AIM OF THE STUDY
Was to summarize data on the role and place of herbal remedies, in particular, the extract from the roots of (EPs 7630) in the treatment of acute sinusitis.
MATERIAL AND METHODS
Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: epidemiology of acute sinusitis, modern treatment of acute sinusitis, colds, herbal remedies, .
RESULTS
Analysis of published clinical trial data demonstrates evidence that EPs 7630 is significantly superior to placebo in reducing the duration and severity of symptoms of acute respiratory infection and indicates the advisability of including an extract from (EPs 7630) roots in OS treatment protocols. The high safety profile and clinically significant efficacy of this drug make EPs 7630 an important component of drug therapy for acute sinusitis.
Topics: Herbal Medicine; Humans; Pelargonium; Phytotherapy; Plant Extracts; Plant Roots; Sinusitis
PubMed: 33720662
DOI: 10.17116/otorino202186011108