Sinusitis is defined as a condition of inflammation
of the paranasal sinuses of which can develop headache as a result of
exposure to a cold or flu virus, or an allergic reaction to pollen,
mold, dust or smoke, etc..Sinusitis affects 37 million people each year.
II. Diagnosis and management
1. Diagnosis is based on symptoms, family history and a physical exam, including endoscopy
to rule abnormality of structure cause of chronic sinusitis including
nasal drainage ,tumor, polyps, or other sinus obstruction by an
endoscopy, a flexible or rigid tube with a lens system for visualization
and a light for illumination to examine the interior of cavity of
several paired paranasal sinuses.
2. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken
around a single axis of rotation, to create a three-dimensional picture
of the inside of the body in details.The pictures are viewed by your
doctor to see the extent of the abnormalities, including a cystic
fibrosis or a tumor. and it is used not only in the initial visit but
also at a later time after medical treatment has been initiated. Dr.
McMurphy AB and the team in the study conducted by 96th Surgical
Operations Squadron/SGCXL, Eglin Air Force Base, said that CT scanning
of the sinuses does not appear to be useful in determining outcomes of
intervention in CF patients(29). Other indicated that CT scan assessment
of chronic rhinosinusitis is a reliable test. The CT findings in
patients with chronic rhinosinusitis remain consistent over time(30)
3. Diagnosis and management of acute sinusitis by pediatricians
In a national random sample of 750 general pediatricians from the
American Medical Association Master File. RESULTS. The response rate was
45% (N = 271). Pediatricians reported first considering acute sinusitis
at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35
(21%), and > or =36 (20%) months. Symptoms thought to be “very
important” in the diagnosis of acute sinusitis included prolonged
symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion
(43%); 60% reported that symptom duration is more important than symptom
combination. Symptom durations expected before considering the
diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16
(38%), and > or =17 (6%) days. Fifty-eight percent reported using
sinus computed tomography scans “occasionally” or more often in the
diagnosis of acute sinusitis. Ninety-six percent reported treating acute
sinusitis with an antibiotic “frequently” or “always.” Fifty-three
percent reported using contingency antibiotic prescriptions
“occasionally” or more often for acute sinusitis. Adjuvants used
“frequently” or “always” included saline washes (44%), systemic
decongestants (28%), nasal corticosteroids (20%), and systemic
antihistamines (13%)(31)
4. Medical management and diagnosis of chronic rhinosinusitis
In a 15-item survey was mailed to a random sample of 200 members of the
American Academy of Otolaryngology-Head and Neck Surgery, 73% defined
CRS as lasting >12 weeks. Seventy-three percent also believed
radiological imaging was necessary for definitive diagnosis, but only
30% believed nasal endoscopy was necessary. Regarding treatment,
respondents reported use of oral antibiotics (94%) and nasal
corticosteroids (94%) as part of maximum medical management; oral
decongestants, oral mucoevacuants, and allergy testing were used only by
about one-half of the respondents, and less frequently topical
decongestants (38%), oral corticosteroids (36%), and oral antihistamines
(27%) were used. Oral corticosteroids were more likely to be used by
specialists that self-classified as rhinologists than by other
otolaryngologists (p = 0.005), but rhinologists were less likely to use
radiological imaging (p = 0.04) as a diagnostic criterion. Pediatric
otolaryngologists used allergy testing in medical management more
frequently than other otolaryngologists (p < 0.001). Overall, the
basis for choice of maximal medical management was personal clinical
experience (74%), rather than clinical research results or expert
recommendations(32)
5. In a Rhinosinusitis diagnosis and management for the clinician:
a synopsis of recent consensus guidelines, for the diagnosis and
management of RS and its subtypes, including acute viral RS, acute
bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal
polyposis, and allergic fungal RS. The Joint Task Force on Practice
Parameters, the Clinical Practice Guideline: Adult Sinusitis, the
European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the
British Society for Allergy and Clinical Immunology. Points of
consensus and divergent opinions expressed in these guidelines regarding
classification, diagnosis, and management of adults with acute RS (ARS)
and CRS and their various subtypes are highlighted for the practicing
clinician. Key points of agreement regarding therapy in the guidelines
for ARS include the efficacy of symptomatic treatment, such as
intranasal corticosteroids, and the importance of reducing the
unnecessary use of antibiotics in ARS; however, guidelines do not agree
precisely regarding when antibiotics should be considered as a
reasonable treatment strategy. Although the guidelines diverge markedly
on the management of CRS, the diagnostic utility of nasal airway
examination is acknowledged by all. Important and relevant data from
MEDLINE-indexed articles published since the most recent guidelines were
issued are also considered, and needs for future research are
discussed(33)
5. Etc.
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Sources
(30) http://www.ncbi.nlm.nih.gov/pubmed/10401840
(31) http://www.ncbi.nlm.nih.gov/pubmed/19171570
(32) http://www.ncbi.nlm.nih.gov/pubmed/16686386
(33) http://www.ncbi.nlm.nih.gov/pubmed/21490181
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