Current Concepts in Adult Acute Rhinosinusitis.

Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory care. Most cases of acute rhinosinusitis are caused by viral upper respiratory infections. A meta-analysis based on individual patient data found that common clinical signs and symptoms were not effective for identifying patients with rhinosinusitis who would benefit from antibiotics. C-reactive protein and erythrocyte sedimentation rate are somewhat useful tests for confirming acute bacterial maxillary sinusitis. Four signs and symptoms that significantly increase the likelihood of a bacterial cause when present are double sickening, purulent rhinorrhea, erythrocyte sedimentation rate greater than 10 mm per hour, and purulent secretion in the nasal cavity. Although cutoffs vary depending on the guideline, antibiotic therapy should be considered when rhinosinusitis symptoms fail to improve within seven to 10 days or if they worsen at any time. First-line antibiotics include amoxicillin with or without clavulanate. Current guidelines support watchful waiting within the first seven to 10 days after upper respiratory symptoms first appear. Evidence on the use of analgesics, intranasal corticosteroids, and saline nasal irrigation for the treatment of acute rhinosinusitis is poor. Nonetheless, these therapies may be used to treat symptoms within the first 10 days of upper respiratory infection. Radiography is not recommended in the evaluation of uncomplicated acute rhinosinusitis. For patients who do not respond to treatment, computed tomography of the sinuses without contrast media is helpful to evaluate for possible complications or anatomic abnormalities. Referral to an otolaryngologist is indicated when symptoms persist after maximal medical therapy and if any rare complications are suspected.

Evaluation of a novel natural drop for treatment of chronic rhinosinusitis without nasal polyps: a single blind randomized trial.

BACKGROUND: The present study investigated the effectiveness of a Pimpinella anisum-based herbal medicine for treating chronic rhinosinusitis (CRS) without polyps in comparison to fluticasone nasal spray, in a single-blinded randomized trial. METHODS: Patients with CRS without nasal polyps were randomly assigned into 2 treatment groups: individuals in the first group (n = 26) received 2 drops of a P. anisum-based herbal medicine (Sinupim) in each nostril every 12 hours, while those in the second group (n = 22) received 2 puffs of fluticasone nasal spray in each nostril every 12 hours. Both groups used their designated treatments for 4 weeks. Patients were evaluated by the 22-item Sino-Nasal Outcome Test (SNOT-22) at the start of the trial and after the completion of their treatment. RESULTS: Although both treatments were effective in reducing patients' symptoms, there were significantly better results in the Sinupim group based on the SNOT-22 evaluation. Mean changes in computed tomography (CT) scan scoring in Sinupim and fluticasone groups before and after treatment were 2.22 ± 2.94 and 0.76 ± 1.39, respectively, which was significant within both groups (p < 0.05). Postnasal drip and nasal obstruction were more significantly improved in the Sinupim group. CONCLUSION: A P. anisum-based herbal medicine may be an effective treatment for sinusitis without polyps. However, its wide acceptance needs further investigation.

Compliance and efficacy of saline irrigation in pediatric chronic rhinosinusitis.

OBJECTIVE: The objective of this study was to evaluate compliance with and effectiveness of nasal irrigation in children with chronic rhinosinusitis (CRS) and to assess its clinical course. METHODS: Seventy-seven children with refractory CRS resistant to medical treatment including antibiotics and nasal corticosteroids were included. We evaluated patients' nasal symptom and Lund Mackay CT scores at baseline. All patients were educated about nasal irrigation and encouraged to perform nasal irrigation 1-3 times a day. After 1 month, patients were reevaluated regarding compliance with the protocol and improvement of CRS by assessing symptom score and endoscopic evaluation. The patients were followed up for at least two months to assess need for further treatment including surgery. RESULTS: Mean age of patients was 8.3 years ranging from 4 to 13 years. Mean follow-up duration with nasal saline irrigation was 6.2 months (2-32 months). Forty nine patients (63.6%) successfully carried out nasal irrigation during follow-up (good compliance [GC] group) and 28 patients (36.4%) did not successfully carry out nasal irrigation (poor compliance [PC] group). There were no significant differences between GC and PC groups regarding clinical characteristics and baseline Lund-MacKay CT scores. Subjective and objective improvements were observed in 36 patients (73.5%) in the GC group and 14 patients (50.0%) in the PC group. Surgery including endoscopic sinus surgery and/or adenoidectomy was performed in 8 patients (16.3%) in the GC group and 12 patients (42.9%) in the PC group. The rate of surgical treatment was significantly different between the groups (p=0.019). CONCLUSION: Nasal irrigation in children with long standing CRS is relatively well tolerated (63.6%) and effective. Nasal saline irrigation should be considered as a primary treatment tool in CRS even in pediatric age group.

Treatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of the herbal drug preparation from the roots of Pelargonium sidoides (EPs 7630) compared to placebo. DESIGN: Double-blind, randomized, placebo-controlled, parallel-group, multicenter trial with a group-sequential adaptive design. SUBJECTS: Patients with sinonasal symptoms of at least 7 days duration, and radiographically and clinically confirmed acute rhinosinusitis of presumably bacterial origin with a Sinusitis Severity Score (SSS) of at least 12 out of 24 points at inclusion. INTERVENTIONS: EPs 7630, a herbal drug preparation from the roots of Pelargonium sidoides (1: 8-10; extraction solvent: ethanol 11% (w/w)), or matching placebo at a dose of 60 drops three times daily for maximum 22 days. MAIN OUTCOME MEASURES: Change in the SSS after 7 days. RESULTS: 103 patients were recruited until the planned interim analysis. The mean decrease in the SSS was 5.5 points in the EPs 7630 group compared to 2.5 points in the placebo group, a difference of 3.0 points (95% confidence interval 2.0 to 3.9, p < 0.00001). This result was confirmed by all secondary parameters indicating a more favourable course of the disease and a faster recovery in the EPs 7630 group. According to the pre-specified decision rule, the study was stopped after obtaining proof of efficacy for EPs 7630. CONCLUSIONS: EPs 7630 was well tolerated and superior in efficacy compared to placebo in the treatment of acute rhinosinusitis of presumably bacterial origin.

[Avelox efficacy in the treatment of acute purulent rhinosinusitis].

AIM: To compare efficacy of avelox systemic antibiotic therapy with and without maxillary puncture in acute purulent rhinosinusitis (ARS). MATERIAL AND METHODS: A total of 40 ARS patients were divided into two groups: puncture was not made in 20 patients of the study group and was made in 20 patients of the control group. Subjective assessment of rhinosinusitis symptoms was made by visual scale Kennedy-Lund, objective assessment was made by x-ray or CT findings. RESULTS: A clinical response was observed in all 40 patients. Complications or side effects associated with avelox administration were not registered. Regress of rhinosinusitis symptoms did not significantly differ between the controls and test patients. The roentgenographic picture did not differ significantly, CT showed that the response came faster without puncture. CONCLUSION: Systemic antibiotic therapy of uncomplicated purulent rhinosinusitis with avelox is not inferior by efficacy to the standard puncture treatment.

Physician specialty is associated with differences in the evaluation and management of acute bacterial rhinosinusitis.

BACKGROUND: Acute bacterial rhinosinusitis (ABRS) is a common illness that is routinely managed by physicians from several different specialties. However, the actual diagnostic and treatment preferences of physicians from these different specialties are not known. OBJECTIVE: To determine whether the radiographic evaluation and management of community-acquired ABRS differs according to medical specialty. DESIGN, SETTING, AND PARTICIPANTS: Randomized survey of 450 board-certified physicians in the United States from family medicine, general internal medicine, and otolaryngology. MAIN OUTCOME MEASURES: Responding physicians' use of diagnostic radiography as well as choice and duration of antimicrobial and adjunctive treatments of ABRS. RESULTS: Otolaryngologists were more likely to use supportive diagnostic radiography (P =.04). They were also more likely to treat patients with adjunctive therapy, such as topical decongestants (P =.01), guaifenesin (P =.01), and saline nasal irrigation (P =.01), in addition to antibiotics. Otolaryngologists prescribed more medications to treat patients with ABRS than primary care physicians (P =.01). There were no significant differences in diagnosis and management by family physicians and general internists. CONCLUSIONS: Otolaryngologists use more health care resources to diagnose and treat ABRS than primary care physicians despite an absence of evidence that such tests and treatments lead to better outcomes. Otolaryngologists typically treat a patient population with a higher prevalence of ABRS and frequently see referred patients with recurrent acute sinusitis and chronic rhinosinusitis, which may explain their tendency to treat patients more aggressively. Nevertheless, these survey results illustrate a lack of consensus within the medical community regarding the evaluation and management of community-acquired ABRS, suggesting that widely accepted evidence-based practice guidelines need to be developed.

[Influence of acupuncture on human nasal mucociliary transport].

The effect of acupuncture on human nasal mucociliary transport was studied by using both 99mTc tagged-particle method (detected by SPECT) and the saccharin method. Results showed that acupuncture on the Yingxiang and Hegu could increase the velocity of the mucociliary transport in chronic rhinitis patients, but not in normal persons.