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Chronic sinusitis — Clinical Guidelines

Overview

Chronic sinusitis is a persistent inflammation of the paranasal sinuses lasting more than 12 weeks, often associated with recurrent symptoms such as nasal congestion, facial pain, and impaired sense of smell 1.

Diagnosis

Clinical Criteria: Persistent symptoms for at least 12 weeks 1.

Diagnostic Tests:

- Imaging: CT scans are commonly used to visualize sinus abnormalities 3. - Questionnaires: Sinonasal questionnaires can aid in screening for chronic sinonasal disease, particularly in pulmonary clinics 2.

Grading: Utilize imaging findings and symptom severity to grade the extent of disease 3.

Management

First-Line Treatments:

- Antibiotics: Considered cautiously due to concerns over antibiotic resistance; use based on culture and sensitivity results 1. - Nasal Corticosteroids: Effective in reducing inflammation 1.

Adjunctive Treatments:

- Endoscopic Sinus Surgery: Indicated for refractory cases where medical management fails 5 8. - Immunological Evaluation: For patients with chronic sinusitis unresponsive to conventional therapy, consider immunodeficiency assessment 9.

Special Populations

Pediatrics: Management trends include a mix of medical and surgical interventions, with variability among practitioners 4.

Comorbidities: Immunodeficient patients may require specific immunoglobulin replacement therapy 9.

Key Recommendations

Utilize CT scans judiciously for diagnosing chronic sinusitis to avoid overutilization 3 (Evidence: Moderate).

Employ sinonasal questionnaires as a screening tool in pulmonary clinics to identify chronic sinonasal disease 2 (Evidence: Moderate).

Consider endoscopic sinus surgery as a definitive treatment option for patients with persistent symptoms despite medical management 5 8 (Evidence: Weak).

Evaluate immunodeficient patients with chronic sinusitis for potential immunoglobulin deficiencies and consider replacement therapy 9 (Evidence: Expert opinion).

References

1 Kostić M, Ivanov M, Babić SS, Petrović J, Soković M, Ćirić A. An Up-to-Date Review on Bio-Resource Therapeutics Effective against Bacterial Species Frequently Associated with Chronic Sinusitis and Tonsillitis. Current medicinal chemistry 2020. link 2 Ussavarungsi K, Limsuwat C, Berdine G, Nugent K. Is the sinonasal questionnaire a useful screening instrument for chronic sinonasal diseases in pulmonary clinics?. Chronic respiratory disease 2013. link 3 Bhattacharyya N. Trends in otolaryngologic utilization of computed tomography for sinonasal disorders. The Laryngoscope 2013. link 4 Sobol SE, Samadi DS, Kazahaya K, Tom LW. Trends in the management of pediatric chronic sinusitis: survey of the American Society of Pediatric Otolaryngology. The Laryngoscope 2005. link 5 Lynn-Macrae AG, Lynn-Macrae RA, Emani J, Kern RC, Conley DB. Medicolegal analysis of injury during endoscopic sinus surgery. The Laryngoscope 2004. link 6 Dastidar P, Numminen J, Heinonen T, Ryymin P, Rautiainen M, Laasonen E. Nasal airway volumetric measurement using segmented HRCT images and acoustic rhinometry. American journal of rhinology 1999. link 7 Fried MP, Topulos G, Hsu L, Jalahej H, Gopal H, Lauretano A et al.. Endoscopic sinus surgery with magnetic resonance imaging guidance: initial patient experience. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1998. link70082-8) 8 Sharp HR, Spraggs PD, Mackay IS. Combined approach intranasal endoscopic and external Lothrop procedure in chronic frontal sinus disease. The Journal of laryngology and otology 1997. link 9 Polmar SH. The role of the immunologist in sinus disease. The Journal of allergy and clinical immunology 1992. link90176-3) 10 Benton JS, Siu K. Chronic inflammatory lesions of the sphenoid sinus. Surgical neurology 1975. link 11 Jokinen K, Raunio V. Penetration of azidocillin into the secretion and tissues in chronic maxillary sinusitis and tonsillitis. Acta oto-laryngologica 1975. link

Chronic sinusitis