Sinusitis Research Paper

Evidence Based Topic Assignment- Sinusitis According to JAMA: Sinusitis is defined as inflammation of one or more paranasal sinuses but usually refers to infection of the sinuses. However not all "sinus" complaints are bacterial sinusitis. The gold standard for diagnosing sinusitis, for clinical research, is through sinus aspiration and culture. Among those pt's who were thought to have sinusitis, only 50% actually had the disease based on sinus aspirates. For general practice, the use of radiography through the use of sinus x-rays, CT, or ultrasound, will correctly classify 4 of 5 pts correctly. This has become the reference standard for primary care. This as well as the pt's symptoms are used to diagnose acute bacterial sinusitis. There
are 3 "major" and 9 "minor" symptoms used. Major ones being: purulent anterior or posterior nasal drainage or cough. Minor ones: headache, facial pain, periorbital edema, halitosis, tooth pain, increased wheeze, or fever. The presence of 2 or more major symptoms or 1 major and at least 2 minor symptoms are required to be sinusitis. Objectively, the documentation of purulent nasal drainage must be visualized by either the clinician or radiographic evidence. (Simel & Rennie,2009) Based on current guidelines and research: First, the term rhinosinusitis is now preferred to sinusitis, as inflammation of the sinuses rarely occurs without inflammation of the nasal mucosa as well. As far as the symptoms and radiographs used to diagnose rhinosinusitis, is still standard. Its goes further to classify it into acute viral and acute bacterial rhinosinusitis. * Acute Viral Rhinosinusitis are symptoms lasting less than 10-14 days are most commonly due to a viral illness and do not require an antibiotic for treatment, as this will not speed up the resolution of the infection.
Recommendations are based on getting rest, drinking plenty of fluids, and symptom relief with appropriate medications (Ferguson & Wise, 2011) These include analgesics such as APAP and NSAIDS for pain relief; Mechanical irrigation with saline spray to thin secretions; Topical corticosteroids reduces inflammation and edema (Hwang & Getz, 2012). * If symptoms persist longer than 2 weeks, the diagnoses of acute bacterial rhinosinusitis is more likely. At this time antibiotic therapy could be indicated. Recent studies have shown identical results with amoxicillin, erythromycin, and Bactrim. The preferred choice is a 10-14 day course of amoxicillin for its low cost/side effect profile. * Viral rhinosinusitis that is complicated by bacterial infection in only 0.5 to 2% of cases. Of those with bacterial infections, 75% will resolve in one month with no treatment. Rarely, will untreated pt's develop a serious complication such as periorbital cellulitis. * Despite the overwhelming prevalence of viral etiology, 85 to 98% of pts in the US, will be prescribed an antibiotic when presenting with a sinus or upper respiratory
infection. Evidence Based Topic Assignment- Sinusitis Reference List Hwang, P.H., MD & Getz, A., MD. (2012). Acute Sinusitis and Rhinosinusitis In Adults. Up To Date. Retrieved from http://uptodate.com/contents/acute-sinusitis- and- rhinosinusitis-in-adults Ferguson, B.J., MD & Wise, S.K., MD. (6/2011). Adult Sinusitis. American Rhinologic Society. Retrieved from http://care.american-rhinologic.org/adult_sinusitis Williams, J.W., Jr., MD,MHS & Simel, D.L., MD,MHS (2009). Does This Patient Have Sinusitis? Simel, D.L., MD,MHS & Rennie, D., MD (Eds.), The Rational Clinical Examination: Evidenced -Based Clinical Diagnoses. (pp. 593- 599). New York, NY: McGraw-Hill.