Rinosinusitis

RHINOSINUSITIS

Clinical practice guideline: adult sinusitis.
Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC 3rd, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJ, Nathan R, Shiffman RN, Smith TL, Witsell DL.

Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31.

I. Presumed ViralRhinosinusitis (VRS)
a. Diagnosis (Statement #1a) - Strong recommendation
b. Radiographic imaging (Statement #1b)- Recommendation against
c. Symptomatic relief (Statement #2)- Option
II. Presumed Acute Bacterial Rhinosinusitis (ABRS)
a. Diagnosis (Statement #1a) Strong recommendation
b. Radiographic imaging (Statement #1b) - Recommendation against
c.Initial management
i. Pain assessment (Statement #3a)- Strong recommendation
ii. Symptomatic relief (Statement #3b)- Option
iii. Watchful waiting (Statement #4)- Option
iv. Antibiotic selection (Statement #5)- Recommendation
d. Treatment failure (Statement #6) – Recommendation
IV. Chronic Rhinosinusitis (CRS) and Recurrent Acute Rhinosinusitisa. Diagnosis (Statement #7a)- Recommendation
b. Modifying factors (Statement #7b)- Recommendation
c. Diagnostic testing (Statement #8a)- Recommendation
i. Nasal endoscopy (Statement #8b)- option
ii. Radiographic imaging (Statement #8c)- Recommendation
iii. Testing for allergy and immune function (Statement #8d) - option
d. Prevention(Statement #9) - Recommendation

Objetivos

1. if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults,

2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detectcomplications,

3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms,

4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, andanatomic variation,

5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis,

6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and

7) clinicians should educate/counsel patients with CRS or recurrent acuterhinosinusitis regarding control measures

ESTADISTICAS

1 in 7 adults in the United States.

31 million individuals diagnosed each year.

The direct annual health-care cost of $5.8 billion stems mainly from ambulatory and emergency department services.

500,000 surgical procedures performed on the paranasal sinuses.

More than 1 in 5 antibiotics prescribed in adults are for sinusitis,fifth most common diagnosis for which an antibiotic is prescribed.

The indirect costs of sinusitis include 73 million days of restricted activity per year

DEFINICIONES

Rhinosinusitis is defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. The term rhinosinusitis

is preferred because sinusitis is almost always accompanied by inflammation of the contiguous nasalmucosa.

Uncomplicated rhinosinusitis is defined as rhinosinusitis without clinically evident extension of inflammation outside the paranasal sinuses and nasal cavity at the time of diagnosis (eg, no neurologic, ophthalmologic, or soft tissue involvement).

classified by duration as:

acute (less than 4 weeks), subacute (4-12 weeks), or chronic (more than 12 weeks, with or without acute...