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The Laryngoscope Oct 2015Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We...
OBJECTIVES AND HYPOTHESIS
Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider-level factors associated with antibiotic use.
STUDY DESIGN
Retrospective cohort at a single academic institution.
METHODS
We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005, and December 31, 2006. We used identify factors associated with receipt of antibiotics.
RESULTS
We find that 66.0% of patients with mild symptoms of short duration are given antibiotics, and that nonclinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics, and emergency medicine providers use more antibiotics for acute sinusitis.
CONCLUSIONS
Antibiotics continue to be overused for patients with mild acute sinusitis of short duration. Nonclinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence use of antibiotics for acute sinusitis.
LEVEL OF EVIDENCE
4.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Female; Humans; Male; Prescription Drug Overuse; Primary Health Care; Retrospective Studies; Sinusitis
PubMed: 26010534
DOI: 10.1002/lary.25363 -
Head and Neck Pathology Mar 2016Fungal rhinosinusitis (FRS) comprises a spectrum of disease processes that vary in clinical presentation, histologic appearances, and biological significance. FRS can be... (Review)
Review
Fungal rhinosinusitis (FRS) comprises a spectrum of disease processes that vary in clinical presentation, histologic appearances, and biological significance. FRS can be acute or chronic and is most commonly classified as non-invasive or invasive based on whether fungi have invaded into tissue. This manuscript will review the pathologic classification of FRS.
Topics: Humans; Mycoses; Rhinitis; Sinusitis
PubMed: 26830404
DOI: 10.1007/s12105-016-0690-0 -
The Laryngoscope Oct 2021Acute rhinosinusitis is a frequent common cold-related complication in children. Despite the need for appropriate treatment, its underlying microbiology remains unclear....
OBJECTIVES/HYPOTHESIS
Acute rhinosinusitis is a frequent common cold-related complication in children. Despite the need for appropriate treatment, its underlying microbiology remains unclear. This study aimed to investigate the microbiology of acute rhinosinusitis in children.
STUDY DESIGN
Prospective non controlled study.
METHODS
Thirty-one pediatric acute maxillary sinusitis patients with severe symptoms were assessed. The subjects were 17 males and 14 females aged 5 to 14 years (mean age, 9.1 years). Maxillary sinus aspirates were collected and cultured, with subsequent viral and bacterial polymerase chain reaction (PCR) analysis. Bacteria were analyzed using culturing and PCR, and viruses were analyzed using PCR. The PCR kits used identify 18 types of respiratory viruses and 13 types of bacteria.
RESULTS
At least one pathogen was detected in 30 of 31 aspirates (97%) using PCR, and none of the aspirates contained respiratory viruses alone. Ten aspirates (32%) contained both viruses and bacteria. The most common viruses detected were rhinovirus (13%) and influenza virus (10%). The most common bacteria were Haemophilus influenzae (45%), Streptococcus pneumoniae (32%), Moraxella catarrhalis (16%), and Chlamydophila pneumoniae (13%). Bacteria were found in 21 of 31 cases (68%) via bacterial culturing. Culturing revealed that H influenzae was the most common pathogen (42%).
CONCLUSIONS
In pediatric acute maxillary sinusitis, respiratory bacteria were detected in 65% of the sinus aspirates and both bacteria and viruses in 32%. The most common viruses were rhinovirus and influenza virus, and the most common bacteria were H influenzae and S pneumoniae. Viral and bacterial PCR is useful for accurately investigating the microbiology in pediatric sinusitis.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E2705-E2711, 2021.
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Male; Maxillary Sinusitis; Polymerase Chain Reaction; Prospective Studies
PubMed: 33939189
DOI: 10.1002/lary.29564 -
Acta Otorhinolaryngologica Italica :... Feb 2015A growing amount of scientific evidence suggests that herbal medicine may be helpful as an adjuvant treatment in rhinosinusitis. Herein, we systematically review and... (Review)
Review
A growing amount of scientific evidence suggests that herbal medicine may be helpful as an adjuvant treatment in rhinosinusitis. Herein, we systematically review and determine the role, efficacy and safety of phytotherapy in the treatment of acute and chronic rhinosinusitis and establish the qualities of herbal drugs as demonstrated by in vitro and in vivo experiments. Eligible studies published in English or German from January 1990 until June 2014 were identified via electronic database searches. Keywords were: sinusitis, phytotherapy, phytomedicine and herbal drugs. Additional studies were obtained through the references of selected articles. Twenty-two articles met inclusion criteria. Overall, the publications indicated that herbal medicines can have mucolytic, antiviral, antimicrobial, anti-inflammatory and secretolytic effects in experimental animals. Phytotherapy has also been found to be efficacious in reducing the symptoms of acute and chronic rhinosinusitis in children and the adult population in vivo, demonstrating a high level of tolerability and safety. Herbal products developed using phytoneering techniques have shown improvements in performance compared with previous formulations. The current literature suggests that phytotherapy is an effective and safe form of ancillary treatment for rhinosinusitis. In particular, herbal drugs made with the technique of phytoneering have proven effective in acute rhinosinusitis.
Topics: Acute Disease; Humans; Phytotherapy; Rhinitis; Sinusitis
PubMed: 26015644
DOI: No ID Found -
Canadian Association of Radiologists... May 2017The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted... (Review)
Review
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
Topics: Humans; Intraoperative Period; Magnetic Resonance Imaging; Mycoses; Rhinitis; Sinusitis; Tomography, X-Ray Computed
PubMed: 28438285
DOI: 10.1016/j.carj.2016.12.009 -
The Pediatric Infectious Disease Journal Dec 2018There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal...
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Child; Humans; Otitis Media; Sinusitis
PubMed: 29570583
DOI: 10.1097/INF.0000000000002009 -
Annals of Family Medicine Mar 2019To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). (Review)
Review
PURPOSE
To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS).
METHODS
We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Acute rhinosinusitis was diagnosed by any valid reference standard, whereas acute bacterial rhinosinusitis (ABRS) was diagnosed by purulence on antral puncture or positive bacterial culture. We used bivariate meta-analysis to calculate summary estimates of test accuracy.
RESULTS
Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51% and ABRS is 31%. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR-] 0.37), normal transillumination (LR- 0.55), the absence of preceding respiratory tract infection (LR- 0.48), any nasal discharge (LR- 0.49), and purulent nasal discharge (LR- 0.54). Based on limited data, the overall clinical impression (LR+ 3.8, LR- 0.34), cacosmia (fetid odor on the breath) (LR+ 4.3, LR- 0.86) and pain in the teeth (LR+ 2.0, LR- 0.77) are the best predictors of ABRS. While several clinical decision rules have been proposed, none have been prospectively validated.
CONCLUSIONS
Among patients with clinically suspected ARS, only about one-third have ABRS. The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. Clinical decision rules, including those incorporating C-reactive protein, and use of urine dipsticks are promising, but require prospective validation.
Topics: Acute Disease; Bacterial Infections; Physical Examination; Rhinitis; Sinusitis
PubMed: 30858261
DOI: 10.1370/afm.2354 -
Journal of the Chinese Medical... Oct 2018The aim of this study was to evaluate the diagnostic efficacy of sinus ultrasound for acute and subacute maxillary sinusitis (ASMS) by investigating the agreement...
BACKGROUND
The aim of this study was to evaluate the diagnostic efficacy of sinus ultrasound for acute and subacute maxillary sinusitis (ASMS) by investigating the agreement between different tools. We also proposed a confirmatory tool directed protocol for adult acute sinusitis, to enhance diagnostic accuracy.
METHODS
This prospective cohort study enrolled patients who were older than 18 years, with a diagnosis of maxillary sinusitis. The duration of symptoms was confined to less than 12 weeks. Rigid nasal endoscopy, sinus ultrasound, and plain sinus film were performed for all patients on the same day to confirm the diagnosis. Kappa statistics were used to test interrater reliability.
RESULTS
A total of 148 maxillary sinuses in 74 patients (38 men, 36 women) were evaluated. Sinus ultrasound and rigid nasal endoscopy disclosed the best agreement (agreement = 0.78, κ = 0.556). The agreement of rigid nasal endoscopy and plain sinus film was relatively poor (agreement = 0.72, κ = 0.446). Sinus ultrasound and plain sinus film had the poorest diagnostic consistency (agreement = 0.67, κ = 0.338).
CONCLUSION
Sinus ultrasound is a quick, safe, cost effective, and relatively easy-to-use technique for clinicians to evaluate the maxillary sinus. Sinus ultrasound and rigid nasal endoscopy are complementary tests to confirm the diagnosis of ASMS.
Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Prospective Studies; Tomography, X-Ray Computed; Ultrasonography; Young Adult
PubMed: 29779998
DOI: 10.1016/j.jcma.2018.03.005 -
Asian Journal of Surgery Jan 2023Acute invasive fungal rhinosinusitis (AIFR) is a rare disease, but the prognosis is by no means ideal. Pathologically, fungal infection is not only located in the sinus... (Review)
Review
Acute invasive fungal rhinosinusitis (AIFR) is a rare disease, but the prognosis is by no means ideal. Pathologically, fungal infection is not only located in the sinus cavity, but also invades the sinus mucosa and bone wall, the surrounding structures and tissues such as the orbit and anterior skull base are often compromised and are accompanied with intracranial and extracranial complications. Despite decades of efforts, acute invasive fungal rhinosinusitis remains a devastating disease, the mortality of the disease continues to hover around 50%. The main impediments to improving the prognosis of acute invasive fungal rhinosinusitis are the difficulties of early diagnosis and the rapid reversal of immune insufficiency. Moreover, aggressive surgery combined with systemic antifungal therapy are significant positive prognostic factors as well. Progress and standardization of AIFR treatment protocols have been limited by the scarcity of the disease and the absence of published randomized studies. Therewith, how to improve the therapeutic outcome and reduce the mortality rate has always been a challenging clinical discussion. We have summarized the relevant case series and literature from the recent years, management with optimal diagnostic and curative strategies are reviewed.
Topics: Humans; Rhinitis; Sinusitis; Paranasal Sinuses; Mycoses; Acute Disease
PubMed: 35589479
DOI: 10.1016/j.asjsur.2022.05.006 -
The British Journal of General Practice... Apr 2020Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic...
BACKGROUND
Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing.
AIM
To describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective.
DESIGN AND SETTING
This was a retrospective cohort study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012.
METHOD
The incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT).
RESULTS
The incidence of brain abscess and acute mastoiditis following AOM were 0.03 (95% confidence interval [CI] = 0.01 to 0.20) and 5.62 (95% CI = 4.81 to 6.56) per 10 000 AOM episodes, respectively. The incidence of brain abscess and orbital cellulitis following AS was 0.11 (95% CI = 0.05 to 0.26) and 1.50 (95% CI = 1.17 to 1.90) per 10 000 AS episodes, respectively. Antibiotic prescription for AOM was associated with lower odds of developing acute mastoiditis (odds ratio [OR] 0.54; 95% CI = 0.37 to 0.79); NNT to prevent one case was 2181 (95% CI = 1196 to 5709). Antibiotic prescribing for AS was associated with lower odds of subsequent brain abscess (OR 0.12; 95% CI = 0.02 to 0.70); NNT to prevent one case was 19 988 (95% CI = 4951 to 167 099). No significant association between antibiotic prescription and development of orbital cellulitis following AS were found (OR 0.56; 95% CI = 0.27 to 1.12).
CONCLUSION
Serious complications following AOM and AS are rare. Antibiotics are associated with lower odds of developing complications, but the NNT are large.
Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain Abscess; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Mastoiditis; Middle Aged; Orbital Cellulitis; Otitis Media; Retrospective Studies; Sinusitis; Young Adult
PubMed: 32152042
DOI: 10.3399/bjgp20X708821