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Adults - Acute Sinusitis

Adults - Acute Sinusitis

Acute sinusitis is difficult to diagnose. Diagnosis depends on obtaining a complete history and physical examination in addition to use of radiographic diagnostic aids and, if necessary, sinus aspiration.

Empirical treatment with antibiotic agents and adjunctive measures should be started. Because most acute sinus infections are caused by H influenzae and S pneumoniae, the preferred antibiotic for treatment is amoxicillin or TMP-SMZ.

Symptoms persisting after completion of an appropriate course of treatment are an indication for referral to an otolaryngologist.

Kankam CG & Sallis R: Acute sinusitis in adults. Difficult to diagnose, essential to treat. Postgrad Med, 1997 Aug, 102:2, 253-8.

Allergic Rhinitis (Sinusitis)

Allergic Rhinitis

Allergic rhinitis affects approximately 20% of the U.S. population. An association between allergic rhinitis and conditions including asthma, sinusitis, otitis media, nasal polyposis, respiratory infections, and even orthodontic malocclusions has been observed.

The positive response of patients afflicted with these conditions to antiallergic treatment further enhances the association between allergic rhinitis and other airway diseases.

In the treatment of acute sinusitis, the combination of an intranasal corticosteroid and an antibiotic provides greater benefit than an antibiotic alone.

Three techniques for the treatment of allergic rhinitis are used, including avoidance of offending allergens, selection of appropriate pharmaceuticals, and allergy immunotherapy.

Spector SL: Overview of comorbid associations of allergic rhinitis. J Allergy Clin Immunol, 1997 Feb, 99:2, S773-80.

Children (1) (Sinusitis)

Children (1)

Evaluated all children undergoing CT scan of the paranasal sinuses for recalcitrant sinusitis symptoms (#153 ).

Categorization into chronic sinusitis (CS) and recurrent acute sinusitis (RAS) based upon pattern of disease and presentation. Eighty-two (55%) children were categorized as RAS and 68 (45%) as CS.

Compared clinical symptoms and signs, radiological examination, treatment, and outcome between these distinct clinical groups.

Children with CS presented more frequently with a persistent cough, purulent nasal discharge, immune deficiency, and more severe mucosal disease on CT than children with RAS.

Medical therapy successfully controlled the symptoms of sinusitis in 79 (96%) with RAS versus 27 (40%) with CS.

Surgery was performed in 44 children: 3 (3.6%) with RAS versus 41 (60%) with CS.

At a mean follow-up of 2 years, >80% of all the children were either asymptomatic or improved regardless of treatment modality.

Weinberg EA et al., Clinical classification as a guide to treatment of sinusitis in children. Laryngoscope, 1997 Feb, 107:2, 241-6.

Childhood (2) (Sinusitis)

Childhood (2)

Epidemiological data, the clinical picture, treatment and complications are described.

The prevalence of significant predisposing conditions (such as upper airway allergy, asthma, and immunoglobulin deficiency) has been estimated.

Improved medication and prevention may have reduced the incidence of serious sinus infections in risk groups today.

Children with cystic fibrosis have been reviewed with regard to the necessity of both sinus and nasal polyp surgery. Aggressive medical therapy appears to have reduced their need for sinus surgery as well as polypectomy.

Henriksson G et al., A 13-year report on childhood sinusitis: clinical presentations, predisposing factors and possible means of prevention. Rhinology, 1996 Sep, 34:3, 171-5.

Children (3) - Otitis Media

Children (3) - Otitis Media

The development of resistance among the bacterial pathogens causing acute otitis media and sinusitis in children is causing considerable concern. Although normally a mild infection, acute otitis media can produce serious complications with sequelae that can have long-lasting effects.

High levels of resistance are now being seen in the three principal pathogens. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

The treatment of sinusitis is complicated by the difficulty in establishing a clear differential diagnosis.

Cohen R: The antibiotic treatment of acute otitis media and sinusitis in children. Diagn Microbiol Infect Dis, 1997 Jan-Feb, 27:1-2, 35-9.

Children (4) - Fungal Sinusitis

Children (4) - Fungal Sinusitis

Determined the optimal treatment in pediatric patients with allergic fungal sinusitis (AFS).

Pediatric patients who fulfilled 5 criteria necessary for diagnosis of AFS:
1. type 1 hypersensitivity;
2. nasal polyposis;
3. characteristic computed tomographic scan;
4. histological evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue; and
5. a positive fungal stain or culture of sinus contents.

All patients were treated with functional endoscopic sinus surgery with removal of fungal debris. Adjuvant therapy included nasal irrigations, postoperative endoscopic cleanings, and systemic corticosteroids in 9 of 10 patients.

The treatment and prognosis of pediatric AFS are similar to those of adult AFS. However, systemic corticosteroids should be weaned aggressively in children to minimize complications, particularly long-term growth retardation.

Kupferberg SB & Bent JP: Allergic fungal sinusitis in the pediatric population. Arch Otolaryngol Head Neck Surg, 1996 Dec, 122:12, 1381-4.

Chronic (Sinusitis)


Symptoms of chronic sinusitis include facial pain, rhinorrhea and malaise. Infection, allergies and vasomotor rhinitis/ sinusitis are the usual causes. Physical examination, laboratory results and routine radiologic findings are often minimal.

Computed tomographic scanning, however, may show pathology that is not apparent on standard radiographs.

Nonpharmacologic treatments should be considered first. Increased exercise and nasal steam inhalation may help.

Dietary restrictions or a change in environment are occasionally quite beneficial.

Intranasal corticosteroids and brief courses of local decongestants are frequently appropriate.

Systemic therapy, including decongestants, anti-inflammatory agents, antibiotics and, occasionally, "antihistamines", offers treatment directed at the causes of chronic sinusitis. When aggressive medical treatment is unsuccessful, nasal surgery, particularly endoscopic surgery may offer significant benefit for selected patients.

Chester AC: Chronic sinusitis. Am Fam Physician, 1996 Feb 15, 53:3, 877-87.

Diagnosis & Treatment (Sinusitis)

Diagnosis & Treatment

The almost simultaneous introduction of nasal endoscopy and CT imaging led to better understanding of normal and pathologic function of the paranasal sinuses.

Diagnosis and treatment of many paranasal sinus diseases improved considerably.

Functional endoscopic sinus surgery (FESS) has become the standard procedure for most surgical cases of chronic sinusitis.

Jorissen M: Recent trends in the diagnosis and treatment of sinusitis. Eur Radiol, 1996, 6:2, 170-6.



Complications and local extension of paranasal sinus infections most often involve the orbit and periorbita.

Because of the widespread use of antibiotics since World War II, intracranial extension of maxillofacial sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential for these complications, because late recognition of this condition and delays in treatment can increase morbidity and mortality rates.

A comprehensive review of sinogenic intracranial complications is presented, with illustrative cases of: brain abscess, subdural empyema, meningitis, cavernous sinus thrombosis, epidural abscess, and osteomyelitis. The mechanisms and potential for intracranial spread of infection from the sinuses are discussed.

Dolan, RW & Chowdhury, K: Diagnosis and treatment of intracranial complications of paranasal sinus infections. J Oral Maxillofac Surg 1995 Sep;53(9):1080-7.

Osteopathic Manipulative Treatment

Osteopathic Manipulative Treatment

The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT).

Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan.

Paul FA & Buser BR: Osteopathic manipulative treatment applications for the emergency department patient. J Am Osteopath Assoc, 1996 Jul, 96:7, 403-9.

Sick Building Syndrome

Sick Building Syndrome

Some of the main complaints of "Sick Building Syndrome" (i.e. lethargy, "headache", and blocked or runny nose) are signs of chronic sinusitis.

Sinusitis is the most common disease in the United States, affecting 31.2 million people, yet it is virtually ignored in general medical publications. It can be caused by indoor, or outdoor, pollution and should be regarded as a possible cause of Sick Building Syndrome. The failure to consider this diagnosis is because it is virtually absent from textbooks.

A MEDLINE search from 1986 to 1990, garnering almost 20,000 articles from mainline journals, found only 10 mentioning acute or chronic sinusitis.

"Sick Building Syndrome and Sinusitis", Chester, Alexander C., The Lancet, January 25, 1992;339:249-250.

Treatment Options

Treatment Options

Recurrent sinusitis is an increasingly important disease in its own right and is an often overlooked underlying trigger for chronic asthma and/or bronchitis. Complications may include intracranial conditions with significant clinical implications.

Patients failing conventional therapy require more aggressive therapy to avoid the necessity for invasive measures, and extensive patient education may help increase compliance with the regimen.

Invasive measures (surgery) for the treatment of recurrent sinusitis carry a serious complication rate of 0.5% in 200,000 cases/ year.

Explored recurrent sinusitis and its pathophysiology, and suggest a medical treatment regimen using nasally inhaled corticosteroids together with antimicrobial and supportive therapy.

Kaliner MA: Recurrent sinusitis: examining medical treatment options. Am J Rhinol, 1997 Mar-Apr, 11:2, 123-32.

Visual Loss

Visual Loss

Visual loss is a rare complication of acute bacterial sinusitis (ABS). Very few cases have been reported in the literature.

Present 3 cases in which significant visual loss was reversed after treatment of ABS.

It appears that immediate surgical drainage with antibiotic therapy may be important in restoring vision.

Galati LT et al., Visual loss reversed after treatment of acute bacterial sinusitis. Laryngoscope, 1996 Feb, 106:2 Pt 1, 148-51.

Vitamin E (Sinusitis)

Vitamin E

Case report of a female patient suffering from yellow nail syndrome (YNS) accompanied by bronchial hyperactivity and sinusitis.

Following treatment of the respiratory pathology and oral administration of vitamin E, there was an improvement in the nails.

Luyten C et al., Yellow nail syndrome and onychomycosis. Experience with itraconazole pulse therapy combined with vitamin E. Dermatology, 1996, 192:4, 406-8.


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