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AAAAI, ACAAI identify new recommendations for sinusitis diagnosis and management
November 30, 2005Sinusitis is one of the most diagnosed diseases in the United States, affecting approximately 16% of the adult population, and is responsible for nearly $5.8 billion in health care costs annually, according to an updated practice parameter. The Diagnosis and Management of Sinusitis: A Practice Parameter Update is featured in the December 2005 issue of the Journal of Allergy & Clinical Immunology (JACI) and is currently available on the JACI's Web site at www.jacionline.org. The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).
The practice parameter provides an updated definition of sinusitis and new recommendations for the diagnosis and management of sinusitis, including predisposing factors, antibiotic use, when to see a specialist, and other diseases associated with sinusitis.
"This practice parameter is intended to improve on the diagnosis and management of patients," said Raymond G. Slavin, MD, MS, FAAAAI, and lead author of the updated practice parameter. "This will result in reduced health care costs, and a better quality of life for patients with sinusitis."
Sinusitis is an inflammation of one or more of the paranasal sinuses, and can be divided into acute, subacute, chronic and recurrent. The classifications are based on how long symptoms last, the specific sinus involved, or both. The updated classification is as follows:
- Acute sinusitis: symptoms for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, purulent rhinorrhea, postnasal drainage, anosmia, nasal congestion, facial pain, headache, fever, cough, and purulent discharge.
- Subacute sinusitis: symptoms from four to eight weeks.
- Chronic sinusitis: symptoms for eight weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis there should be abnormal findings on CT or MRI. Some patients with chronic sinusitis might present with vague or insidious symptoms.
- Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.
The two most common predisposing conditions to developing sinusitis are viral upper respiratory tract infections and allergic rhinitis. Allergic rhinitis is one of the most common chronic diseases, affecting up to 35.9 million Americans annually.
The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. The Diagnosis and Management of Sinusitis: A Practice Parameter Update recommends:
- The diagnosis of acute sinusitis should be primarily based on the history and physical examination of the patient. Imaging techniques such as radiographs or CT scans are not necessary.
- Antibiotics should be withheld for 10 to 14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye.
- The primary therapy for acute bacterial sinusitis is antibiotics, but with increasing resistance to penicillin being reported, alternative antibiotics may be necessary.
- Referral to an allergist/immunologist, particularly for patients with chronic or recurrent sinusitis associated with certain conditions, and in patients who have undergone prior surgical procedures and continue to experience sinusitis.
- Surgery is a consideration only after medical therapy has failed.
According to the practice parameter and the AAAAI, referral to an allergist/immunologist should be sought when:
- The patient suffers chronic, recurrent infectious or fungal rhinosinusitis.
- There is a need to clarify whether an allergic or immune deficiency condition is playing a role.
- If the sinusitis does not respond to the usual antibiotic treatment.
- If the sinusitis significantly affects performance and quality of life.
- The sinusitis co-exists with allergic rhinitis.
Working with an allergist/immunologist, the best qualified medical professional trained to manage the prevention, diagnosis and treatment of sinusitis and other allergic diseases, will demonstrate improved outcomes and quality of life for people suffering from allergic disease.
American Academy of Allergy, Asthma & Immunology
Sinusitis is an inflammation of one or more of the paranasal sinuses, and can be divided into acute, subacute, chronic and recurrent. The classifications are based on how long symptoms last, the specific sinus involved, or both. The updated classification is as follows:
- Acute sinusitis: symptoms for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, purulent rhinorrhea, postnasal drainage, anosmia, nasal congestion, facial pain, headache, fever, cough, and purulent discharge.
- Subacute sinusitis: symptoms from four to eight weeks.
- Chronic sinusitis: symptoms for eight weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis there should be abnormal findings on CT or MRI. Some patients with chronic sinusitis might present with vague or insidious symptoms.
- Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.
The two most common predisposing conditions to developing sinusitis are viral upper respiratory tract infections and allergic rhinitis. Allergic rhinitis is one of the most common chronic diseases, affecting up to 35.9 million Americans annually.
The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. The Diagnosis and Management of Sinusitis: A Practice Parameter Update recommends:
- The diagnosis of acute sinusitis should be primarily based on the history and physical examination of the patient. Imaging techniques such as radiographs or CT scans are not necessary.
- Antibiotics should be withheld for 10 to 14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye.
- The primary therapy for acute bacterial sinusitis is antibiotics, but with increasing resistance to penicillin being reported, alternative antibiotics may be necessary.
- Referral to an allergist/immunologist, particularly for patients with chronic or recurrent sinusitis associated with certain conditions, and in patients who have undergone prior surgical procedures and continue to experience sinusitis.
- Surgery is a consideration only after medical therapy has failed.
According to the practice parameter and the AAAAI, referral to an allergist/immunologist should be sought when:
- The patient suffers chronic, recurrent infectious or fungal rhinosinusitis.
- There is a need to clarify whether an allergic or immune deficiency condition is playing a role.
- If the sinusitis does not respond to the usual antibiotic treatment.
- If the sinusitis significantly affects performance and quality of life.
- The sinusitis co-exists with allergic rhinitis.
Working with an allergist/immunologist, the best qualified medical professional trained to manage the prevention, diagnosis and treatment of sinusitis and other allergic diseases, will demonstrate improved outcomes and quality of life for people suffering from allergic disease.
American Academy of Allergy, Asthma & Immunology
Sinusitis News and Current Sinusitis Events RSSBreaking the 'mucus barrier' with a new drug delivery system
Chemical engineers from Johns Hopkins University have broken the "mucus barrier," engineering the first drug-delivery particles capable of passing through human mucus - regarded by many as nearly impenetrable - and carrying medication that could treat a range of diseases. Those conditions include lung cancer, cervical cancer and cystic fibrosis, the research noted in a presentation scheduled for the 236th National Meeting of the American Chemical Society.
'Stuffy nose' mouse: A promise to help treat 31 million with sinusitis
Mice with inflamed nasal tissue being tested at a Johns Hopkins laboratory may be unable to tell if something smells bad or good, but their sensory deficit is nothing to turn up a nose at.
Immune system kick-started in moist nasal lining in sinusitis, asthma and colds
Scientists at Johns Hopkins have outlined a new path for potential therapies to combat inflammation associated with sinusitis and asthma based on a new understanding of the body's earliest immune response in the nose and sinus cavities.
Potential blood test for chronic sinusitis identified
A protein profile has been identified in the blood of chronic sinusitis sufferers that may enable physicians to objectively diagnosis and treat the disease, researchers say.
Some common treatments for sinus infections may not be effective
A comparison of common treatments for acute sinusitis that included an antibiotic and a topical steroid found neither more effective than placebo, according to a study in the December 5 issue of JAMA.
GPs antibiotic prescribing practices are still contributing to resistance
GPs are still prescribing antibiotics for up to 80% of cases of sore throat, otitis media, upper respiratory tract infections, and sinusitis, despite the fact that official guidance warns against this practice.
Survey shows asthma not controlled in majority of patients
A survey of 1,812 patients with moderate-to-severe asthma revealed that the disease was not controlled in 55 percent, despite the fact that most had health insurance and visited their health care providers regularly.
Antibiotics appear to be overprescribed for sinus infections
Antibiotics are prescribed for approximately 82 percent of acute sinus infections and nearly 70 percent of chronic sinus infections, despite the fact that viruses are by far the most frequent cause of this condition, according to a report in the March issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.
Tearing down the fungal cell wall
Scientists at the Virginia Bioinformatics Institute and Duke University Medical Center have pinpointed a fungal gene that appears to play an important role in the development and virulence of Alternaria brassicicola.
Hopkins scientists link immune response to 'ghost' parasites and severely congested sinuses
Although it's unclear why it's so, scientists at Johns Hopkins have linked a gene that allows for the chemical breakdown of the tough, protective casing that houses insects and worms to the severe congestion and polyp formation typical of chronic sinusitis.
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