Prolonged sinusitis
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Prolonged Sinusitis: Diagnosis, Risk Factors, and Management
Diagnosis of Prolonged Sinusitis
Symptoms and Diagnostic Tools
Prolonged sinusitis, often referred to as chronic sinusitis, presents with a range of nonspecific symptoms such as facial pressure, headache, nasal obstruction, and drainage. These symptoms can overlap with other conditions like common colds and perennial rhinitis, making diagnosis challenging. Physical examination is crucial to exclude anatomical causes, but a negative examination does not rule out sinusitis. Additional diagnostic tools include nasal cytology, ultrasound, flexible or rigid nasal endoscopy, and imaging tests like radiology and computed tomography 1.
Risk Factors and Prognosis
Predictive Factors for Prolonged Course
Several factors can predict a prolonged course of acute sinusitis. These include female sex, a history of symptoms lasting longer than 14 days, presenting with headache, cold, or cough, and the absence of cervical adenopathy. Interestingly, antibiotic treatment does not significantly influence the course of the disease, which is generally self-limiting 2.
Sinusitis in Special Populations
In patients with prolonged nasotracheal intubation, sinusitis can be a hidden source of sepsis. This condition is often underdiagnosed but can be confirmed through sinus x-rays, computed tomography, or clinical evaluation. Treatment typically involves antibiotics and changing the intubation route 3. Similarly, in pediatric patients, especially those with congenital malformations requiring prolonged intubation, sinusitis can lead to sepsis. Diagnosis in these cases is complicated by delayed pneumatization of the sinuses, making radiologic evidence less reliable 6.
Management Strategies
General Management
Sinusitis is a common diagnosis in primary care, often leading to significant morbidity and time off work. Despite the frequent prescription of antibiotics, most cases resolve without them, even if bacterial in origin. The challenge lies in distinguishing between viral and bacterial sinusitis, as their symptoms are closely similar 4.
Surgical and Pharmacological Interventions
In cases where multiple courses of antibiotics fail, surgical interventions like antral lavage and creation of nasoantral windows may be necessary, especially in children. Amoxicillin is generally effective, but antibiotics targeting beta-lactamase-producing bacteria should be considered in refractory cases. The role of antihistamines, decongestants, nasal steroids, and cromolyn sodium remains unstudied 9.
Conclusion
Prolonged sinusitis requires a multifaceted diagnostic approach due to its nonspecific symptoms and overlap with other conditions. Predictive factors can help identify patients at risk for a prolonged course, and while antibiotics are commonly prescribed, they are not always necessary. Special populations, such as those with prolonged intubation or pediatric patients, require careful monitoring and tailored management strategies. Further research is needed to optimize diagnostic techniques and treatment modalities.
Sources and full results
Most relevant research papers on this topic
Diagnosis of sinusitis in adults: history, physical examination, nasal cytology, echo, and rhinoscope.
Chronic sinusitis is diagnosed through a combination of history, physical examination, nasal cytology, echo, and rhinoscope, with a focus on detecting disease in the paranasal sinus cavities.
Determinants for the course of acute sinusitis in adult general practice patients
In general practice, acute sinusitis is mostly self-limiting, with a few characteristics predicting a slightly prolonged clinical course.
Observational StudyParanasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis.
Nasotracheal intubation can lead to unrecognized paranasal sinusitis, which can be successfully treated with antibiotics and tracheostomy or oral tube movement.
Highly CitedSinusitis and its management
Sinusitis is generally caused by a viral upper respiratory tract infection, with only 2% being complicated by bacterial sinusitis.
Systematic Review
Rigorous JournalHighly CitedBacterial sinusitis: etiology and surgical management
Bacterial sinusitis is a common cause of acute and chronic upper respiratory tract infections in children, with bacterial sinusitis being the second most common cause of chronic cough in children.
Sinusitis: hidden source of sepsis in postoperative pediatric intensive care patients.
Prolonged nasal intubation in young infants can lead to unrecognized sources of sepsis due to delayed pneumatization of the sinuses and mastoids.
Case ReportAcute Sinusitis—Principles of Judicious Use of Antimicrobial Agents
Antimicrobial agents should be used cautiously for acute sinusitis, as viral rhinosinusitis is more common and requires less antibiotic treatment.
Highly CitedSinusitis in children infected with human immunodeficiency virus: clinical characteristics, risk factors, and prophylaxis. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group.
Sinusitis in HIV-infected children is often subacute and recurrent, with no significant decrease in the risk from monthly IVIG prophylaxis or trimethoprim-sulfamethoxazole prophylaxis.
RCT
Large Human TrialSinusitis in children.
Sinusitis is common in allergic children, with persistent cough and purulent rhinorrhea being the most common symptoms, and often accompanied by middle ear disease and immunoglobulin disorders.
Highly Cited