Sinusitis resident survival guide

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Sinusitis Resident Survival Guide Microchapters
Overview
Causes
Diagnosis and Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: Approach to bacterial sinusitis, Approach to viral sinusitis, Approach to sinusitis, Sinusitis workup, Sinusitis management

Overview

Rhinosinusitis is the inflammation of the nasal mucosa and paranasal sinuses. The terms sinusitis and rhinosinusitis are used interchangeably, although rhinosinusitis is preferred because inflammation of the paranasal sinuses rarely ever occurs without concurrent inflammation of the nasal mucosa. The cause of rhinosinusitis is mostly infectious, although it can be associated with other medical conditions such as allergies. The diagnosis is primarily clinical and imaging and other diagnostic studies are not necessary for diagnosis.


Causes

Life Threatening Causes

  • Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
  • There are no known causes of life-threatening causes of sinusitis.

Common Causes

Infectious causes of rhinosinusitis include viruses, bacteria, and fungi:[1][2]


Diagnosis and Treatment

  • The diagnosis of sinusitis according to The Infectious Diseases Society of America is based on the presence of at least 2 major or 1 major and ≥2 minor of the following symptoms:[3]
Sinusitis diagnosis criteria
Major symptoms Minor symptoms
Purulent anterior nasal discharge Headache
Purulent or discolored posterior nasal discharge Otalgia, ear pressure, or fullness
Nasal congestion or obstruction Halitosis
Facial congestion or fullness Dental pain
Facial pain or pressure Cough
Hyposmia or anosmia Fatigue
Fever




 
 
 
 
 
 
 
 
 
 
Adult with possible sinusitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Duration ≤ 4w
 
 
 
Duration 4-12w
 
 
 
Duration ≥ 12w
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Meets criteria for acute rhinosinusitis?
 
 
 
“Subacute” sinusitis excluded from guideline
 
 
 
Signs and symptoms of chronic rhinosinusitis?
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral upper respiratory infection
 
Yes
 
 
 
 
 
 
 
 
 
Yes
 
Not chronic rhinosinusitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Meets criteria for acute bacterial rhinosinusitis?
 
Yes
 
Acute bacterial rhinosinusitis
 
Documented sinonasal inflammation?
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral acute rhinosinusitis
 
 
 
 
 
Yes
 
Complication suspected?
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain radiologic imaging
 
No
 
Chronic rhinosinusitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do not obtain radiologic imaging
 
Confirm the presence or absence of nasal polyps
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Absense of complications?
 
Recommend symptomatic relief for acute bacterial rhinosinusitis
 
Recommend saline nasal irrigation and/or topical intranasal corticosteroids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Manage complication and acute bacterial rhinosinusitis
 
 
 
 
 
Offer watchful waiting OR prescribe antibiotic based on shared decision-making
 
Recommend saline nasal irrigation and/or topical intranasal corticosteroids
 
Do not prescribe topical or systemic antifungal therapy
 
Assess patient for chronic conditions that would modify management
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Decision to proceed with watchful waiting
 
 
 
 
 
Decision to proceed with initial antibiotic therapy
 
 
 
 
 
Option of testing for allergy and immune function
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Offer a safety-net or wait-and-see antibiotic prescription
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical or surgical management as appropriate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment failure
 
Yes
 
Prescribe amoxicillin, with or without clavulanate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Treatment failure?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Recurrent acute bacterial rhinosinusitis?
 
 
No
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
Exclude complications and other causes of illness; if diagnosis of acute bacterial rhinosinusitis is confirmed prescribe an alternate antibiotic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Management complete
  • The diagnosis of sinusitis according to them is based on the presence of at least 2 major or 1 major and ≥2 minor of the following symptoms:
Sinusitis diagnosis criteria
Major symptoms Minor symptoms
Purulent anterior nasal discharge Headache
Purulent or discolored posterior nasal discharge Ear pain, pressure, or fullness
Nasal congestion or obstruction Halitosis
Facial congestion or fullness Dental pain
Facial pain or pressure Cough
Hyposmia or anosmia Fatigue
Fever


Do's


Don'ts


References

  1. Brook I (2011). "Microbiology of sinusitis". Proc Am Thorac Soc. 8 (1): 90–100. doi:10.1513/pats.201006-038RN. PMID 21364226.
  2. deShazo RD, Chapin K, Swain RE (1997). "Fungal sinusitis". N. Engl. J. Med. 337 (4): 254–9. doi:10.1056/NEJM199707243370407. PMID 9227932.
  3. Chow, Anthony W.; Benninger, Michael S.; Brook, Itzhak; Brozek, Jan L.; Goldstein, Ellie J. C.; Hicks, Lauri A.; Pankey, George A.; Seleznick, Mitchel; Volturo, Gregory; Wald, Ellen R.; File, Thomas M. (2012). "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults". Clinical Infectious Diseases. 54 (8): e72–e112. doi:10.1093/cid/cis370. ISSN 1058-4838.
  4. DeMuri, Gregory P.; Wald, Ellen R. (2012). "Acute Bacterial Sinusitis in Children". New England Journal of Medicine. 367 (12): 1128–1134. doi:10.1056/NEJMcp1106638. ISSN 0028-4793.
  5. Rosenfeld, Richard M.; Piccirillo, Jay F.; Chandrasekhar, Sujana S.; Brook, Itzhak; Ashok Kumar, Kaparaboyna; Kramper, Maggie; Orlandi, Richard R.; Palmer, James N.; Patel, Zara M.; Peters, Anju; Walsh, Sandra A.; Corrigan, Maureen D. (2015). "Clinical Practice Guideline (Update): Adult Sinusitis". Otolaryngology–Head and Neck Surgery. 152 (2_suppl): S1–S39. doi:10.1177/0194599815572097. ISSN 0194-5998.
  6. "www.cenetec.salud.gob.mx" (PDF).
  7. 7.0 7.1 7.2 "www.cenetec.salud.gob.mx" (PDF).
  8. Hoxworth, Joseph M.; Glastonbury, Christine M. (2010). "Orbital and Intracranial Complications of Acute Sinusitis". Neuroimaging Clinics of North America. 20 (4): 511–526. doi:10.1016/j.nic.2010.07.004. ISSN 1052-5149.
  9. Cornelius, Rebecca S.; Martin, Jamie; Wippold, Franz J.; Aiken, Ashley H.; Angtuaco, Edgardo J.; Berger, Kevin L.; Brown, Douglas C.; Davis, Patricia C.; McConnell, Charles T.; Mechtler, Laszlo L.; Nussenbaum, Brian; Roth, Christopher J.; Seidenwurm, David J. (2013). "ACR Appropriateness Criteria Sinonasal Disease". Journal of the American College of Radiology. 10 (4): 241–246. doi:10.1016/j.jacr.2013.01.001. ISSN 1546-1440.
  10. Setzen, Gavin; Ferguson, Berrylin J.; Han, Joseph K.; Rhee, John S.; Cornelius, Rebecca S.; Froum, Stuart J.; Gillman, Grant S.; Houser, Steven M.; Krakovitz, Paul R.; Monfared, Ashkan; Palmer, James N.; Rosbe, Kristina W.; Setzen, Michael; Patel, Milesh M. (2012). "Clinical Consensus Statement". Otolaryngology–Head and Neck Surgery. 147 (5): 808–816. doi:10.1177/0194599812463848. ISSN 0194-5998.
  11. Cornelius, Rebecca S.; Martin, Jamie; Wippold, Franz J.; Aiken, Ashley H.; Angtuaco, Edgardo J.; Berger, Kevin L.; Brown, Douglas C.; Davis, Patricia C.; McConnell, Charles T.; Mechtler, Laszlo L.; Nussenbaum, Brian; Roth, Christopher J.; Seidenwurm, David J. (2013). "ACR Appropriateness Criteria Sinonasal Disease". Journal of the American College of Radiology. 10 (4): 241–246. doi:10.1016/j.jacr.2013.01.001. ISSN 1546-1440.
  12. Eddy, D. M. (1992). "Clinical decision making: from theory to practice. Cost-effectiveness analysis. Will it be accepted?". JAMA: The Journal of the American Medical Association. 268 (1): 132–136. doi:10.1001/jama.268.1.132. ISSN 0098-7484.

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