In this post, I link to and excerpt from Clinical Practice Guideline (Update): Adult Sinusitis [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39.
Here are excerpts:
Abstract
Objective. This update of a 2007 guideline from the American Academy of Otolaryngology—Head and Neck Surgery
Foundation provides evidence-based recommendations to
manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS).Purpose. The purpose of this multidisciplinary guideline is to
identify quality improvement opportunities in managing adult
rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also
placed on identifying multiple chronic conditions that would
modify management of rhinosinusitis, including asthma, cystic
fibrosis, immunocompromised state, and ciliary dyskinesia.Action statements. The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and
recurrent ARS from isolated episodes of ABRS and other
causes of sinonasal symptoms; (5) should assess the patient
with CRS or recurrent ARS for multiple chronic conditions
that would modify management, such as asthma, cystic fibrosis,
immunocompromised state, and ciliary dyskinesia; (6) should
confirm the presence or absence of nasal polyps in a patient
with CRS; and (7) should recommend saline nasal irrigation,
topical intranasal corticosteroids, or both for symptom relief of
CRS. The update group stated as options that clinicians may (1)
recommend analgesics, topical intranasal steroids, and/or nasal
saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.Keywords
adult sinusitis, rhinosinusitisIntroduction
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