rhinosinusitis
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Clinical manifestations
- rhinitis
- nasal obstruction
- purulent mucus in the middle meatus
- anterior or posterior mucopurulent drainage
- polyps in the nasal cavity or middle meatus
- decreased sense of smell
- sinusitis
- facial pain, pressure or fullness
- purulent mucus in the ethmoid sinus :
- chronic rhinosinusitis
- 12 weeks duration
- >= 2 of
- facial pain, pressure or fullness
- nasal obstruction
- purulent mucus in the middle meatus
- anterior or posterior mucopurulent drainage
- decreased sense of smell
- recurrent rhinosinusitis
- >= 4 episodes/year of acute bacterial rhinosinusitis occur without signs/symptoms of rhinosinusitis between episodes
Laboratory
* meets diagnostic criteria
Diagnostic procedures
- nasal & sinus endoscopy with biopsy*
* meets diagnostic criteria
Radiology
- CT of paranasal sinuses
- imaging showing inflammation of the paranasal sinuses*
* meets diagnostic criteria
Management
- nasal glucocorticoids first line treatment
- improve nasal congestion
- do not improve asthma symptoms
- underutilized[5]
- intranasal mometasone for chroninc rhinosinusitis without polyposis[6]
- antibiotics generally not indicated
- common clinical signs & symptoms do not identfy patients for whom antibiotic treatment is justified[1]
- antibiotics are not indicated for acute rhinosinusitis[6]
- antibiotics are not indicated even if symptoms persist for > 7-10 days[1]
- antibiotics may be indicated for
- symptoms lasting > 10 days +
- severe symptom onset or
- high fever + purulent nasal discharge or
- facial pain lasting >= 3 days or
- worsening symptoms after a viral illness that was improving[4]
- treatment for acute baterial rhinosinusitis is amoxicillin clavulanate[7]
- amoxicillin alone is less effective due to resistance of Haemophilus influenzae
- endoscopic sinus surgery improves sleep & quality of life in patients with chronic rhinosinusitis
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 Young J, De Sutter A, Merenstein D et al Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. 2008 Mar 15;371(9616):908-14. PMID: https://pubmed.ncbi.nlm.nih.gov/18342685
- ↑ Dixon AE et al. Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma. J Allergy Clin Immunol 2015 Mar; 135:701. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25174863 <Internet> http://www.jacionline.org/article/S0091-6749%2814%2900957-9/abstract
Greenberger PA. Will a nasal corticosteroid improve control for patients with step 3 or higher persistent asthma? J Allergy Clin Immunol 2015 Mar; 135:710. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25630938 <Internet> http://www.jacionline.org/article/S0091-6749%2814%2903710-5/abstract - ↑ Alt JA et al. Quality of life in patients with chronic rhinosinusitis and sleep dysfunction undergoing endoscopic sinus surgery: A pilot investigation of comorbid obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2015 Sep 10 PMID: https://pubmed.ncbi.nlm.nih.gov/26356240
- ↑ 4.0 4.1 Harris AM, Hicks LA, Qaseem A et al Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. Published online 19 January 2016 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26785402 <Internet> http://annals.org/article.aspx?articleid=2481815
- ↑ 5.0 5.1 Rudmik L, Xu Y, Liu M et al Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis. A Canadian Population-Based Analysis. JAMA Otolaryngol Head Neck Surg. August 25, 2016 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/27560503 <Internet> http://archotol.jamanetwork.com/article.aspx?articleid=2546533
- ↑ 6.0 6.1 6.2 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 7.0 7.1 NEJM Knowledge+ Allergy/Immunology
- ↑ Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11:213-739. PMID: https://pubmed.ncbi.nlm.nih.gov/33236525
- ↑ Acute rhinosinusitis in Adults: Guidelines for Clinical Care University of Michigan Health System http://cme.med.umich.edu/pdf/guideline/rhino05.pdf