Sinusitis update

Current Opinion in Allergy and Clinical Immunology

Volumn 3, Issue 1, 2003, Pages 33-38

  Mucha, Samantha M ^a   Baroody, Fuad M ^a,b  

^a UNIVERSITY OF CHICAGO   (United States)

^b MC1035   (United States)

Author keywords

Inflammation; Intranasal steroids; Rhinosinusitis; Therapy

Indexed keywords

AMOXICILLIN; AMOXICILLIN PLUS CLAVULANIC ACID; ANTIBIOTIC AGENT; BUDESONIDE; CLARITHROMYCIN; COTRIMOXAZOLE; CYTOKINE; DECONGESTIVE AGENT; FLUTICASONE; GATIFLOXACIN; MOMETASONE FUROATE; STEROID;

ALLERGIC RHINITIS; ANTIBIOTIC THERAPY; ASTHMA; BACTERIUM CULTURE; CHRONIC INFLAMMATION; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; ENDOSCOPIC SURGERY; ENDOSCOPY; EOSINOPHIL; ETHMOID SINUS; HEALTH CARE COST; HUMAN; INFLAMMATION; MORBIDITY; PATHOPHYSIOLOGY; PRIORITY JOURNAL; RECURRENT DISEASE; REVIEW; RHINOSINUSITIS; SINUSITIS; T LYMPHOCYTE; TH2 CELL; UNITED STATES;

ANTI-BACTERIAL AGENTS; ANTI-INFLAMMATORY AGENTS; ENDOSCOPY; HUMANS; NASAL DECONGESTANTS; RHINITIS; SINUSITIS; STEROIDS; TOMOGRAPHY, X-RAY COMPUTED;

EID: 0037311362     PISSN: 15284050     EISSN: None     Source Type: Journal    
DOI: 10.1097/00130832-200302000-00006     Document Type: Review

References (43)

1. Sokol W. Epidemiology of sinusitis in the primary care setting: results from the 1999-2000 respiratory surveillance program. Am J Med 2001; 111:19S-24S.
2. Osguthorpe JD. Surgical outcomes in rhinosinusitis: what we know. Otolaryngol Head Neck Surg 1999; 120:451-453.
3. Ray NFR, Baraniuk JN, Thamer M, et al. Direct expenditures for the treatment of allergic rhinoconjunctivitis in 1996, including the contributions of related airway illnesses. J Allergy Clin Immunol 1999; 103:401-407.
4. Piccirillo JF, Merritt MG, Richards ML. Psychometric and clinimetric validity of the 20-item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 2002; 126:41-47. The 20-item Sino-Nasal Outcome Test is a modification of the 31-item Rhinosinusitis Outcome Measure based on patient and physician input. Patients with and without rhinosinusitis completed this measure their initial visit and at 6 months and 1 year later. The measure was shown to have good internal consistency as well as good content, discriminant, and concurrent validity and moderate sensitivity to clinical change. Patients with higher scores were more affected by rhinosinusitis.
5. Benninger MS, Senior BA. The development of the rhinosinusitis disability index. Arch Otolaryngol Head Neck Surg 1997; 123:1175-1179.
6. Metson RB, Gliklich RE. Clinical outcome in patients with chronic sinusitis. Laryngoscope 2000; 110:S24-S28.
7. Cunningham MJ, Chiu EJ, Landgraf JM, Glicklich RE. The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg 2000; 126:1363-1368.
8. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg 1997; 117 (3 Pt 2):S1-S7.
9. Finegold SM, Flynn MJ, Rose FV, et al. Bacteriologic findings associated with chronic bacterial maxillary sinusitis in adults. Clin Infect Dis 2002; 35:428-433. This is an open-label, multicenter study using maxillary antral punctures of 150 patients, with 176 organisms isolated from 114 patients and 134 considered pathogens. Anaerobes made up 47.8% of isolates, higher than the majority of studies previously done with smaller numbers of patients. The high number here may be due to the careful processing of the specimens.
10. Ramadan HH. What is the bacteriology of chronic sinusitis in adults? Am J Otolaryngol 1995; 16:303-306.
11. Biel MA, Brown CA, Levinson RM, et al. Evaluation of the microbiology of chronic maxillary sinusitis. Ann Otol Rhinol Laryngol 1998; 107 (11 Pt 1):942-945.
12. Brook I. Bacteriology of chronic maxillary sinusitis in adults. Ann Otol Rhinol Laryngol 1989; 98:426-428.
13. Rombaux P, Gigi J, Hamoir M, et al. Bacteriology of chronic sinusitis: the bulla ethmoidalis content. Rhinology 2002; 40:18-23. Enterobacteriaceae species were found with high frequency in the bulla ethmoidalis in 148 specimens from 77 patients undergoing endoscopic sinus surgery for CRS. This species was previously thought to infect patients with catheters or nasogastric tubes, but is possibly a factor in community-acquired chronic ethmoid sinusitis. This finding may change the initial antimicrobial therapy for patients with chronic ethmoid sinusitis.
14. Ozcan M, Unal A, Aksaray S, et al. Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis. Rhinology 2002; 40:24-27. A sterile technique was used to obtain cultures from the middle meatus and the ethmoid sinus from 193 nasal cavities in 127 patients undergoing endoscopic sinus surgery for CRS. No growth was found in 32.3% while the same bacterial species were found in both the middle meatus and the ethmoid sinus in 59.3% of cultures, giving an overall correlation rate of 91.6%. For patients with chronic ethmoidal rhinosinusitis, a sterile middle meatal culture can be used to direct antimicrobial therapy.
15. Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999; 74:877-884.
16. Cody DT, Neel HB, Ferreiro JA, Roberts GD. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope 1994; 104:1074-1079.
17. Lacroix JS, Ricchetti A, Lew D, et al. Symptoms and clinical and radiological signs predicting the presence of pathogenic bacteria in acute rhinosinusitis. Acta Otolaryngol 2002; 122:192-196. Nasopharyngeal cultures were obtained endoscopically from 265 patients with symptoms of acute rhinosinusitis. Pathogenic bacteria were isolated in 29% of cultures, which correlated significantly with facial pain, colored nasal discharge, and radiologic evidence of sinusitis. These parameters, however, had a low sensitivity and specificity for presence of pathogenic bacteria. As such, mild to moderate signs and symptoms of acute rhinosinusitis are poor predictors of bacterial presence.
18. Stankiewicz JA, Chow JM. Nasal endoscopy and the definition and diagnosis of chronic rhinosinusitis. Otolaryngol Head Neck Surg 2002; 126:623-627. Endoscopic and CT scan findings were prospectively compared in 78 patients meeting the criteria for CRS before treatment. When endoscopic findings were negative, 78% of patients had no or minimal disease on CT scan. Positive endoscopic findings also correlated well with CT scan abnormalities, especially when purulence, nasal polyposis, or congested polypoid mucosa were present.
19. Gwaltney JM, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994; 330:25-30.
20. Ashraf N, Bhattacharyya N. Determination of the 'incidental' Lund score for the staging of chronic rhinosinusitis. Otolaryngol Head Neck Surg 2001; 125:483-486. The Lund-Mackay CT scoring system for rhinosinusitis is well accepted and reliable. This study aimed to score patients undergoing CT scans for reasons other than sinus-related symptoms to obtain an acceptable range for normal patients. Out of 91 patients who had complete CT scans, including the osteomeatal unit, the mean Lund score was 4.26, indicating that a score of 0-5 could be considered 'normal'.
21. Jones NS. CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol 2002; 27:11-17.
22. Mudgil SP, Wise SW, Hopper KD, et al. Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings. Ann Allergy Asthma Immunol 2002; 88:223-226. Questionnaires about facial pain and CT scans were obtained for 200 patients referred by internists or otolaryngologists for clinical sinusitis. Radiologists were blinded to patient responses and scored the CT scans based on air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts. The maxillary sinus was most commonly involved while the right temple/forehead was the most common site of pain. There was no correlation between sinonasal pain symptoms and CT scan abnormalities.
23. Krouse JH. Computed tomography stage, allergy testing, and quality of life in patients with sinusitis. Otolaryngol Head Neck Surg 2000; 123:389-392.
24. Arango P, Kountakis SE. Significance of computed tomography pathology in chronic rhinosinusitis. Laryngoscope 2001; 111:1779-1782.
25. Harlin SL, Ansel DG, Lane SR, et al. A clinical and pathologic study of chronic sinusitis: the role of the eosinophil. J Allergy Clin Immunol 1988; 81:867-875.
26. Baroody FM, Hughes CA, McDowell P, et al. Eosinophilia in chronic childhood sinusitis. Arch Otolaryngol Head Neck Surg 1995; 121:1396-1402.
27. Hamilos DL, Leung YM, Wood R, et al. Chronic hyperplastic sinusitis: association of tissue eosinophilia with mRNA expression of granulocyte-macrophage colony-stimulating factor and interleukin-3. J Allergy Clin Immunol 1993; 92:39-48.
28. Brinke AT, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol 2002; 109:621-626. CT scan scores (0-30), lung function, peripheral and sputum eosinophilia, and levels of exhaled nitric oxide were assessed for 89 adult patients with severe asthma. Extensive sinus disease (CT score 12-30) was found in 24% of patients. There was a significant positive correlation between CT score and peripheral as well as sputum eosinophils. Patients with higher CT scores had higher functional residual capacity and lower diffusion capacity, especially with adult-onset asthma. The study suggests that there is a strong relationship between sinonasal and bronchial mucosal inflammation and patients with severe adult-onset asthma should be screened for rhinosinusitis, even when no symptoms are present.
29. Driscoll PV, Naclerio RM, Baroody FM. CD4+ Lymphocytes are increased in the sinus mucosa of children with chronic sinusitis. Arch Otolaryngol Head Neck Surg 1996; 122:1071-1076.
30. Hamilos DL, Leung DY, Wood R, et al. Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis. J Allergy Clin Immunol 1995; 96:537-544.
31. Lavigne F, Nguyen CT, Cameron L, et al. Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis. J Allergy Clin Immunol 2000; 105:746-751.
32. Piccirillo JF, Mager DE, Frisse ME, et al. Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA 2001; 286:1849-1856. This is a very large retrospective cohort study with 29 102 patients clinically diagnosed with acute sinusitis who received either a first-line or second-line antibiotic. Cure and complication rates were not significantly different between the groups, but the cost for treatment with a second-line antibiotic was US$66.19 more than that with a first-line antibiotic. While there was no placebo group or confirmatory testing, the results support using a first-line antibiotic for patients meeting the criteria for ABRS as defined in the text.
33. Garbutt JM, Goldstein M, Gellman E, et al. A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics 2001; 107:619-625.
34. Sher LD, McAdoo MA, Bettis RB, et al. A multicenter, randomized, investigator-blinded study of 5- and 10-day gatifloxacin versus 10-day amoxicillin/clavulanate in patients with acute bacterial sinusitis. Clin Ther 2002; 24:269-281. This study compares the efficacy of using gatifloxacin in a 5- or 10-day course versus amoxicillin/clavulanate for assumed acute bacterial rhinosinusitis in 445 patients. Overall cure rates and drug-related adverse events were similar for all groups. For patients who had mucosal thickening on sinus radiograph, cure rates were significantly higher in the gatifloxacin groups. A short course of gatifloxacin may then be better tolerated by patients in terms of compliance and adverse events in treating acute rhinosinusitis.
35. Meltzer EO, Orgel A, Backhaus JW, et al. Intranasal flunisolide spray as an adjunct to oral antibiotic therapy for sinusitis. J Allergy Clin Immunol 1993; 92:812-823.
36. Meltzer EO, Charous BL, Busse WW, et al. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. J Allergy Clin Immunol 2000; 106:630-637.
37. Dolor RJ, Witsell DL, Hellkamp AS, et al. Comparison of cefuroxime with or without intranasal fluticasone for the treatment of rhinosinusitis. JAMA 2001; 286:3097-3105. This is a double-blind, randomized, placebo-controlled multicenter trial of 95 patients with a history of CRS or recurrent acute rhinosinusitis, having an acute episode of rhinosinusitis, treated with cefuroxime and xylometazoline (10 days each) and either intranasal fluticasone or placebo nasal spray for 21 days. There was a significantly higher rate of clinical success and faster rate of improvement in the fluticasone group, indicating that fluticasone is a useful adjunctive therapy in patients with recurrent acute or chronic rhinosinusitis, having an acute episode.
38. Parikh A, Scadding GK, Darby Y, Baker RC. Topical corticosteroids in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial using fluticasone propionate aqueous nasal spray. Rhinology 2001; 39:75-79.
39. Lavigne F, Cameron L, Renzi PM, et al. Intrasinus administration of topical budesonide to allergic patients with chronic rhinosinusitis following surgery. Laryngoscope 2002; 112:858-864. This is a double-blind, placebo-controlled trial of 26 patients allergic to house dust mites who had persistent rhinorrhea or facial pain after endoscopic sinus surgery, refractory to oral antibiotics and intranasal corticosteroids. Patients instilled either budesonide or placebo through an intubation device into one maxillary sinus for 3 weeks. Symptom scores and biopsies were obtained before and after treatment. Symptom scores were more significantly reduced for a longer duration and there was a significant decrease in eosinophils and cells expressing IL-4 and IL-5 in the budesonide group when compared with placebo.
40. Damm M, Quante G, Jungehuelsing M, Stennert E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope 2002; 112:310-315. This is an open prospective study of 279 patients who underwent endoscopic sinus surgery for CRS and filled out QOL questionnaires before and after surgery. Improvement in two or more major complaints (most commonly nasal obstruction and postnasal drip) for at least two ranking steps was found in 76.4% of patients. Even though a validated QOL outcome measure was not used, significant improvement in QOL was achieved by 85% of patients in the study after endoscopic sinus surgery.
41. Dhong H-J, Jung YS, Chung S-K, Choi D-C. Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis. Otolaryngol Head Neck Surg 2001; 124:99-104.
42. Palmer JN, Conley DB, Dong RG, et al. Efficacy of endoscopic sinus surgery in the management of patients with asthma and chronic sinusitis. Am J Rhinol 2001; 15:49-53.
43. Dunlop G, Scadding GK, Lund VJ. The effect of endoscopic sinus surgery on asthma: management of patients with chronic rhinosinusitis, nasal polyposis, and asthma. Am J Rhinol 1999; 13:261-265.