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The Medical Clinics of North America Sep 2010The patient with "sinus" is common. However, an accurate diagnosis for a patient's sinus complaints may be elusive. The diagnostic uncertainty with these patients is a... (Review)
Review
The patient with "sinus" is common. However, an accurate diagnosis for a patient's sinus complaints may be elusive. The diagnostic uncertainty with these patients is a result of nonspecific symptoms, subtle or absent physical examination findings, and limited diagnostic testing options. Rhinitis should be distinguished from sinusitis. In acute illness, viral upper respiratory tract infection should be distinguished from acute bacterial sinusitis. For patients with chronic sinus symptoms, objective evidence of paranasal sinus inflammation should be confirmed before labeling the patient with chronic sinusitis.
Topics: Administration, Oral; Anti-Bacterial Agents; Humans; Physical Examination; Rhinitis; Sinusitis
PubMed: 20736100
DOI: 10.1016/j.mcna.2010.05.013 -
The Pediatric Infectious Disease Journal Oct 2013Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based...
OBJECTIVE
Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for sinusitis but who nevertheless have a viral URI.
METHODS
We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for acute sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for sinusitis. We examined the utility of signs and symptoms in identifying children with URI.
RESULTS
Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal versus abnormal radiographs.
CONCLUSIONS
Among children meeting current criteria for the diagnosis of acute sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected sinusitis; their absence favors a diagnosis of URI.
Topics: Acute Disease; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Prospective Studies; Respiratory Tract Infections; Sinusitis; Treatment Outcome
PubMed: 23694838
DOI: 10.1097/INF.0b013e31829bb2c2 -
Canadian Family Physician Medecin de... Nov 1994Sinusitis, which primarily involves the anterior ethmoid air cells, can spread to the larger sinus cavities to cause acute and chronic secondary infection. Endoscopic... (Review)
Review
Sinusitis, which primarily involves the anterior ethmoid air cells, can spread to the larger sinus cavities to cause acute and chronic secondary infection. Endoscopic and computed tomographic techniques enable earlier diagnosis and treatment of sinusitis and permanent cure. Primary care physicians should try to identify the disease before it reaches a stage where endoscopic control becomes difficult. Ultrasonography is now used in Europe to diagnose sinusitis and initiate treatment.
Topics: Humans; Sinusitis; Tomography, X-Ray Computed; Ultrasonography
PubMed: 7841828
DOI: No ID Found -
American Family Physician Sep 1998Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this... (Review)
Review
Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure. Fiberoptic telescopes are used for diagnosis and during the procedure, and computed tomography is used to assess the anatomy and identify diseased areas. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus energy.
Topics: Endoscopy; Humans; Sinusitis; Tomography, X-Ray Computed
PubMed: 9750539
DOI: No ID Found -
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 -
Journal of the Pediatric Infectious... Mar 2021We conducted a retrospective cohort study of 160 hospitalized children admitted for acute complicated sinusitis and compared children with S anginosus-associated...
We conducted a retrospective cohort study of 160 hospitalized children admitted for acute complicated sinusitis and compared children with S anginosus-associated infection to children with other or no pathogens identified. The incidence of S anginosus-associated infections increased 12% per year, and infections with S anginosus are associated with increased morbidity.
Topics: Child; Cohort Studies; Humans; Incidence; Retrospective Studies; Sinusitis; Streptococcal Infections; Streptococcus anginosus
PubMed: 31925948
DOI: 10.1093/jpids/piz098 -
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 -
Canadian Family Physician Medecin de... Jan 2008
Review
Topics: Acute Disease; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Nasal Decongestants; Prognosis; Respiratory Therapy; Sinusitis; Tomography, X-Ray Computed
PubMed: 18208963
DOI: No ID Found -
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 -
Anales de Pediatria (Barcelona, Spain :... Mar 2011The aim of this systematic review is to assess whether antibacterial agents are more effective than either placebo or no intervention at all in the treatment of acute... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this systematic review is to assess whether antibacterial agents are more effective than either placebo or no intervention at all in the treatment of acute bacterial sinusitis.
PATIENTS AND METHODS
We reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The results were combined using meta-analysis. We used the fixed effects model or random model depending on whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval.
RESULTS
Only two RCTs had a Jadad scale score ≥3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to 1.3). Variable relapse-recurrence (3 RCTs): RR 0.9 (95% CI: 0.6 to 1.5). Adverse effects (4 RCTs): 2.01 (95% CI 1.1 to 3.8).
CONCLUSIONS
In children with acute sinusitis, antibacterial agents at the studied doses did not appear to provide benefit in terms of cure and improvement, assessed at 10 to 14 days of follow up. Similarly, the percentage of relapse-recurrence was not lower among children who received antibiotics. Antibiotics are associated more frequently with adverse effects.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Humans; Randomized Controlled Trials as Topic; Sinusitis
PubMed: 21237732
DOI: 10.1016/j.anpedi.2010.10.011