Materiały źródłowe

• #1 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute rhinosinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] Acute rhinosinusitis is a clinical diagnosis. Three cardinal symptoms that are most sensitive and specific for acute rhinosinusitis are purulent nasal drainage accompanied by either nasal obstruction or facial pain/pressure/fullness. This must be elucidated specifically from patients who will present with generic „headache” complaints. Isolated headache is not a symptom of sinusitis (with the rare exception of sphenoid sinusitis, which can present as an occipital or vertex headache and is usually chronic), but facial pressure is. The astute clinician must elicit this history from the patient to determine the exact symptoms they are experiencing.

• #1 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute rhinosinusitis is a clinical diagnosis. The clinician most commonly needs to distinguish between VRS and ABRS, which is crucial to ensure the responsible usage of antibiotics. Local resistance patterns and prevalence of penicillin non-susceptible S. pneumoniae requires elucidation. […] Conventional diagnostic criteria for rhinosinusitis in adults is the patient having at least two major or one major plus two or more minor symptoms. The criteria in children are similar except that there is more of an emphasis on nasal discharge (rather than nasal obstruction). Major symptoms include purulent anterior nasal discharge, purulent or discolored posterior nasal discharge, nasal congestion or obstruction, facial congestion or fullness, facial pain or pressure, hyposmia or anosmia, and fever (for acute sinusitis only).

• #1 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  ABRS can be differentiated from VRS using the following clinical guidance: Duration of symptoms for more than ten days, high fever (over 39 C or 102 F) with purulent nasal discharge or facial pain that last for 3 to 4 consecutive days at the beginning of the illness, and double worsening of symptoms within the first ten days. […] Treatment of ABRS consists of either antibiotic therapy or a period of watchful waiting so long as the certainty of reliable follow-up. The American Academy of Otolaryngology Adult Sinusitis 2015 updated guideline recommends amoxicillin with or without clavulanate in adults as first-line therapy for a period of 5 to 10 days in most adults. Treatment failure is noted if symptoms do not decrease within 7 days or worsen at any time. […] Most causes of acute bacterial rhinosinusitis are viral. Most cases will resolve spontaneously. There is evidence that acute bacterial rhinosinusitis (ABRS) can also resolve spontaneously. The diagnosis of ABRS is clinical.

• #1 Diagnosis of Acute Sinusitis – ENT Health

  https://www.enthealth.org/be_ent_smart/diagnosis-of-acute-sinusitis/

  You have acute sinusitis when there has been up to 4 weeks of cloudy or colored (not clear) drainage from the nose plus one or both of the following: (a) a stuffy, congested, or blocked nose or (b) pain, pressure or fullness in the face, head, or around the eyes. […] Acute viral sinusitis is likely if you have been sick less than 10 days and are not getting worse. […] Acute bacterial sinusitis is likely when you do not improve at all within 10 days of getting sick or when you get worse within 10 days after beginning to get better. […] Because sinusitis is treated differently based on cause: acute viral sinusitis does not benefit from antibiotics, but some patients with acute bacterial sinusitis may get better faster with an antibiotic.

• #1 Clinical Diagnosis of Acute Bacterial Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p758.html

  Which patients presenting with symptoms of acute rhinosinusitis have acute bacterial rhinosinusitis? […] Acute bacterial rhinosinusitis develops in only 0.5% to 2% of all upper respiratory tract infections. […] There is no consensus on the diagnostic criteria for acute bacterial rhinosinusitis. […] The American Academy of OtolaryngologyHead and Neck Surgery recommends diagnosing acute bacterial rhinosinusitis when symptoms or signs of acute rhinosinusitis (purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both) persist without evidence of improvement for at least 10 days after the onset of symptoms, or when symptoms or signs of acute rhinosinusitis worsen within 10 days of initial improvement or milder phase of illness (double sickening). […] In 2017, a clinical prediction rule was created for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis using 175 adult Danish patients in whom acute maxillary sinusitis was clinically suspected.

• #1 Clinical Diagnosis of Acute Bacterial Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p758.html

  About one-third of patients with acute rhinosinusitis have a bacterial cause. […] This clinical prediction rule is limited by the need for a point-of-care CRP measurement, which is unavailable in many primary care practices. […] Because no clinical prediction rule for acute bacterial rhinosinusitis has been validated and undergone impact analysis, physicians must rely on guidance from existing studies and guidelines. […] Patients who are more likely to have acute bacterial rhinosinusitis, and thus more likely to benefit from antibiotics, may be those with tender maxillary sinuses, maxillary toothache, a preceding upper respiratory tract infection, cacosmia, or an overall positive physician impression.

• #1 Acute sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/diagnosis-treatment/drc-20351677

  A health care provider might ask about symptoms and do an exam. The exam might include feeling for tenderness in the nose and face and looking inside the nose. […] Other ways to diagnose acute sinusitis and rule out other conditions include: […] Nasal endoscopy. A health care provider inserts a thin, flexible tube, known as an endoscope, into the nose. A light on the tube allows the provider to see inside the sinuses. […] Imaging studies. A CT scan can show details of the sinuses and nasal area. It’s not usually used for simple acute sinusitis. But imaging studies might help rule out other causes. […] Nasal and sinus samples. Lab tests aren’t often used to diagnose acute sinusitis. But if the condition doesn’t get better with treatment or gets worse, tissue samples from the nose or sinuses might help find the cause. […] For acute sinusitis, questions to ask your provider include: What tests do I need?

• #1 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  The accuracy rate of clinical impression ranges from 55 to 75 percent, compared with punctures and radiographs. […] Among the signs and symptoms used to increase the likelihood of a correct diagnosis of acute sinusitis are double sickening (biphasic illness), pain with unilateral prominence, purulent rhinorrhea by history, purulent secretions in the nasal cavity on examination, a lack of response to decongestant or antihistamine therapy, facial pain above or below both eyes on leaning forward, and maxillary toothache. […] The differential diagnosis of acute sinusitis includes protracted upper respiratory infection, dental disease, nasal foreign body, migraine or cluster headache, temporal arteritis, tension headache and temporomandibular disorders. […] Imaging studies are not cost effective in the initial assessment and treatment of patients with clinical findings suggestive of acute sinusitis. Radiographs, however, may be helpful in uncertain or recurrent cases.

• #1

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  In a primary care setting, a good history and physical examination to detect the presence of most or all of the commonly manifesting signs and symptoms can provide a reliable diagnosis of acute sinusitis. The presence of purulent secretions has the highest positive predictive value for diagnosing sinusitis clinically. […] Differentiating it from a common viral URTI is most important. Mucus in URTIs is typically not described as persistently purulent. Nasal congestion is a predominant symptom without persistent or worsening head congestion, headache, or facial pain or fatigue. URTI symptoms would be expected to peak on about day 3 to 5 and resolve within 7 to 10 days. Most other diagnostic modalities, described later, aid in the differential diagnosis of persistent nasal symptoms. […] The two modalities most commonly used include the plain radiograph and CT scan. Plain radiography does not adequately represent the individual ethmoid air cells, the extent of mucosal thickening in chronic sinusitis, or visualization of the ostiomeatal complex.

• #1 Accuracy of Signs and Symptoms for the Diagnosis of Acute Rhinosinusitis and Acute Bacterial Rhinosinusitis | Annals of Family Medicine

  https://www.annfammed.org/content/17/2/164

  PURPOSE To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). […] Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51% and ABRS is 31%. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR] 0.37), normal transillumination (LR 0.55), the absence of preceding respiratory tract infection (LR 0.48), any nasal discharge (LR 0.49), and purulent nasal discharge (LR 0.54). […] The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. […] Only about one-third of patients with clinically suspected ARS have a positive bacterial culture of antral puncture fluid. Acute rhinosinusitis as diagnosed by any reference standard is significantly less likely in patients without any nasal discharge, without a complaint of purulent nasal discharge, and with normal transillumination. The overall clinical impression is also useful for both ruling in and ruling out ARS. Evidence regarding diagnosis of ABRS is limited, but we conclude that the overall clinical impression, pain in the teeth, and cacosmia are the most useful findings for clinicians trying to identify patients most likely to benefit from antibiotics. Clinical decision rules, including those incorporating C-reactive protein, and the use of urine dipsticks to test the nasal discharge are promising, but all require prospective validation.

• #1 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Acute sinusitis is the swelling and inflammation of the lining of paranasal sinuses, an air-filled extension of the nasal cavity. It may obstruct fluid drainage leading to the accumulation of mucus within the sinuses. […] How is sinusitis diagnosed? Your doctor will inquire about your symptoms, and check for the tender area, take a look inside your nasal passages to see if there is an abnormality that can help with the diagnosis of sinusitis. […] Special studies and investigations that help confirm the diagnosis and exclude other conditions are: Nasal endoscopy: Your doctor will insert an endoscope (thin, flexible tube) with fiber-optic light for direct inspection of the interior of the sinus cavity. Imaging studies: A CT scan of your nasal passages can help detect abnormalities or possible complications. For uncomplicated acute sinusitis, there is no need to do an imaging study. Nasal and sinus samples: Tests on tissue samples are usually not necessary. However, if symptoms do not respond to treatment or are worse, a culture of the nasal samples can help confirm the diagnosis of bacterial infection. Allergy testing: If allergies are considered a possible cause, get skin prick testing to confirm the cause of the acute symptoms. Allergy testing is easy and painless and helps identify the allergen causing acute sinusitis.

• #1 UC Davis Health | Department of Otolaryngology | Diagnosis of Sinusitis

  https://health.ucdavis.edu/otolaryngology/specialty/sinus-center/diagnosis-of-sinusitis.html

  The symptoms of sinusitis are not unique to the disease itself. Other disease processes can mimic sinusitis including the common cold, allergies, migraine headache, chronic daily headache, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea. Therefore an accurate diagnosis requires a thorough history and physical examination. This will document the timing, duration, severity of the symptoms, what interventions have previously been performed and the success of each. […] Nasal endoscopy is also used to make the diagnosis of sinusitis. This procedure involves passing a fiber-optic telescope, or „endoscope,” into the nose and examining the interior of the nasal cavity. […] While nasal endoscopy plays a major role in the diagnosis of sinusitis, this procedure can only give information about the openings of the sinuses (unless the patient has had previous surgery to widen the natural openings). Therefore another tool, called computerized tomography or a CT scan, is used to visualize the sinus interior. The CT scan provides information about swelling within the sinuses and also provides a road map of sinus anatomy should surgery be necessary.

• #1 Sinusitis – Wikipedia

  https://en.wikipedia.org/wiki/Sinusitis

  The diagnosis of sinusitis is based on the symptoms and their duration along with signs of disease identified by endoscopic and/or radiologic criteria. […] In the initial evaluation of sinusitis an otolaryngologist, also known as an ear, nose and throat (ENT) doctor, may confirm sinusitis using nasal endoscopy. […] Diagnostic imaging is not usually needed in acute stage unless complications are suspected. […] For sinusitis lasting more than 12 weeks, a CT scan is recommended. […] Nasal endoscopy and clinical symptoms are also used to make a positive diagnosis. […] Health care providers distinguish bacterial and viral sinusitis by watchful waiting. […] If a person has had sinusitis for fewer than 10 days without the symptoms becoming worse, then the infection is presumed to be viral.

• #1 Rhinosinusitis and the role of imaging | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/8/485

  Acute, uncomplicated rhinosinusitis is a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease, or in surgical planning. […] Imaging in the setting of acute uncomplicated rhinosinusitis has not been shown to change clinical outcomes. […] Acute, uncomplicated bacterial or viral rhinosinusitis is a clinical diagnosis, and patients who meet diagnostic criteria for uncomplicated rhinosinusitis should not undergo imaging. […] When complications of rhinosinusitis or spread of infection are suspected, imaging can be considered. […] CT without contrast enhancement is the gold standard of sinus imaging and often the first test performed when complications of rhinosinusitis are suspected, as it affords the best delineation of bone and allows for visualization of bony integrity and erosion.

• #1 Acute Sinusitis Workup: Approach Considerations, Blood Studies, Tests for Immunodeficiency

  https://emedicine.medscape.com/article/232670-workup

  Imaging studies are not necessary when the probability of sinusitis is either high or low but may be useful when the diagnosis is in doubt, based upon a thorough history and physical examination. […] CT scanning is the preferred imaging method for rhinosinusitis. A screening sinus CT scan is adequate for diagnosis and less expensive than other methods but is necessary only in cases of treatment failure or chronic rhinosinusitis. […] CT scanning has poor specificity for the diagnosis of acute sinusitis, demonstrating sinus air-fluid levels in 87% of individuals with simple upper respiratory tract infections and 40% of asymptomatic individuals. […] CT scanning can provide valuable information regarding the anatomic and mechanical contributions in the development of acute sinusitis. […] Radiographic findings in patients with acute sinusitis include diffuse opacification, mucosal thickening (4 mm), or an air fluid level. These findings, in conjunction with clinical features of acute sinusitis, are helpful in confirming the diagnosis.

• #1 Acute Sinusitis Workup: Approach Considerations, Blood Studies, Tests for Immunodeficiency

  https://emedicine.medscape.com/article/232670-workup

  MRI is useful only if fungal infection or a tumor is suggested. MRI is excellent for evaluating soft tissue disease within the sinuses, but it is of little value in the diagnostic workup for acute sinusitis. […] Ultrasonography is of limited use. A-mode ultrasonography may be useful in screening for fluid in the maxillary sinus. […] Cultures of nasal secretions are of limited value because they usually are contaminated by normal flora. Consequently, cultures are not routinely obtained in the evaluation of acute sinusitis; however, they should be obtained in a patient in intensive care or with immunocompromise, in children not responding to appropriate medical management, and in patients with complications of sinusitis. […] Fiberoptic sinus endoscopy is used to visualize posterior sinonasal structures. This test is useful to help exclude structural lesions, fungal disease, and granulomatous diseases.

• #1 Acute Sinusitis Workup: Approach Considerations, Blood Studies, Tests for Immunodeficiency

  https://emedicine.medscape.com/article/232670-workup

  In June 2013, the American Academy of Pediatrics published updated guidelines on the diagnosis and management of acute bacterial sinusitis in children and adolescents. Changes include the following: […] Some authors have reported on the use of laboratory tests, including sedimentation rate, white blood cell counts, and C-reactive protein levels, to help diagnose acute sinusitis. These tests appear to add little to the predictive value of clinical findings in the diagnosis. […] According to the AAAAI 2005 practice parameter, evaluation of acute, chronic, or recurrent sinusitis might include the following laboratory tests: nasal cytology, nasal-sinus biopsy, or tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction. […] The 2015 guidelines recommend that clinicians should not obtain radiographic imaging in patients who meet diagnostic criteria for acute sinusitis unless a complication or alternative diagnosis is suspected.

• #1 Diagnosis and Management of Acute Rhinosinusitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7121979/

  The European Academy of Allergology and Clinical Immunology (EAACI) recommends a query for allergic symptoms such as sneezing, watery rhinorrhea, nasal itching, and itchy watery eyes. […] Other factors that must be considered include unilateral symptoms (foreign body, tumor), history of trauma or prior surgery, presence of immunosuppression or systemic disease (Wegeners granulomatosis, sarcoidosis), or impairments in mucociliary clearance (cystic fibrosis, primary ciliary dyskinesia). […] The gold standard for sinus culture has been the maxillary sinus tap via a trocar through the canine fossa or with a needle through the inferior meatus. […] Culture-directed therapy, although ideal, has remained elusive in the majority of cases of acute rhinosinusitis. […] Although not routine, serologic markers for inflammation may be helpful in the diagnosis of ABRS.

• #1 Medical Treatment for Acute Sinusitis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/861646-workup

  Some authors have reported on the use of laboratory tests, including sedimentation rates, white blood cell counts, and C-reactive protein levels, to help diagnose acute sinusitis. These tests appear to add little to the predictive value of clinical findings in the diagnosis. […] Cultures are not routinely obtained in the evaluation of acute sinusitis but should be obtained in a patient in intensive care or with immunocompromise, in children not responding to appropriate medical management, and in patients with complications of sinusitis. […] Imaging studies are not necessary when the probability of sinusitis is either high or low but may be useful when the diagnosis is in doubt, based upon a thorough history and physical examination. […] CT scanning has poor specificity for the diagnosis of acute sinusitis, demonstrating sinus air-fluid levels in 87% of individuals with simple URTIs and 40% of asymptomatic individuals. […] Magnetic resonance imaging (MRI) is excellent for evaluating soft tissue disease within the sinuses, but it is of little value in the diagnostic workup for acute sinusitis.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-sinusitis.aspx

  A X ray of all the sinuses. Normal sinuses show up as hollow black cavities on either side of the forehead, bridge of the nose, behind the eyes and under the cheek bones. When inflamed the sinuses appear to be blocked with white discharge and this is visible on X rays. […] A new method of inspecting the insides of the sinuses is the fiberoptic endoscope or the rhinoscope. This is a thin flexible tube with a camera and a light at its tip. The nasal passages are lubricated with local anesthetics and the scope is passed. The inside walls and linings of the sinuses may be visualized with this instrument. […] Sinus puncture is a method of obtaining a sample of the fluid from the sinuses using a long thin needle. This helps in detection of the organism causing the sinusitis. This is not routinely practiced.

• #1 Sinusitis: appropriate diagnosis and management | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/sinusitis-diagnosis-and-management/

  Diagnosis: The diagnosis of ABRS is based on clinical symptomatology and therefore taking good history is very important. […] The diagnosis of ABRS requires the presence of at least two major symptoms, one of which must be nasal obstruction (O) or nasal discharge (D) from the following four major symptoms easily remembered using the mnemonic PODS. […] A basic but thorough physical exam of the ear, nose and throat should be conducted by the family doctor. […] If an acute sinusitis is diagnosed on history and physical exam, there is no indication for further radiologic or other testing. […] Imaging studies are not necessary for non-severe ABRS. CT is the modality of choice but is usually reserved for failed medical therapy, chronic rhinosinusitis or for surgical planning. […] When a patient with sinusitis does not improve on medical management or has unilateral symptoms, he/she should be referred for further workup.

• #1 UC Davis Health | Department of Otolaryngology | Diagnosis of Sinusitis

  https://health.ucdavis.edu/otolaryngology/specialty/sinus-center/diagnosis-of-sinusitis.html

  Each of these modalities (i.e., history and physical examination, nasal endoscopy, and CT scan) plays an important role in the diagnosis of sinusitis. Any single study in isolation is of much less value, while the use of all four modalities is most effective in making an accurate diagnosis and treatment plan.

• #1 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Acute rhinosinusitis (ARS) is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks. The term „rhinosinusitis” is preferred to „sinusitis” since inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa. […] The clinical manifestations and diagnosis of ARS are discussed separately. (See „Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis.”) […] Initial evaluation involves identifying complicated infection, which warrants urgent management, and identifying bacterial infection, which warrants antibiotic therapy in selected patients. […] Identify features suggestive of bacterial infection — Because alternate management may be warranted in patients with bacterial infection, it is important to identify these patients at the time of presentation. A clinical diagnosis of ABRS can be made in patients who have persistent ARS symptoms for at least 10 days without improvement; or a biphasic pattern of illness (ie, initial improvement with worsening five to six days later).

• #1 Diagnosis and Management of Acute Rhinosinusitis

  https://www.myprivia.com/greenvilleent/news/diagnosis-and-management-of-acute-rhinosinusitis

  A diagnosis of rhinosinusitis is probable if 2 or more major symptoms, or 1 major and 2 or more minor symptoms are present. […] If symptoms persist beyond 10 days, or if there is an acute worsening after 5 days, treatment should include an antibiotic prescribed by your doctor. […] Antibiotic course should be of 14 days duration to ensure complete response and avoid selection of resistant bacteria. […] Persistence of purulent drainage beyond 5 days after starting antibiotic therapy should trigger a return visit to the doctor. […] Any severe worsening of symptoms despite antibiotic therapy, such as facial or eye swelling, fever 102, or cognitive changes is a medical emergency. Patients should seek immediate medical attention, as these symptoms may represent a vision-threatening or life-threatening complication of sinusitis.

• #1 02. Sinusitis | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/02-sinusitis/02-sinusitis

  Most patients with a single episode of acute sinusitis have a viral etiology and improve without antibiotics. […] Recurrent acute sinusitis or chronic sinusitis that does not respond to antibiotics and nasal steroids warrants an ENT referral. […] Diagnosis is clinical. According to the IDSA, ABRS in setting of viral URI should be considered when major/minor signs/symptoms are present 10 days or more beyond the onset of upper respiratory symptoms, or major/minor signs/symptoms worsen within 10 days after initial improvement (called double-sickening) or fever 39C with purulent nasal discharge or facial pain for 3-4 days at the beginning of an illness. […] Recurrent acute rhinosinusitis: 4 or more episodes of acute rhinosinusitis per year, each lasting longer than 7-10 days, with complete resolution of signs/symptoms in between episodes (distinguishes it from chronic rhinosinusitis).

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-sinusitis.aspx

  When fungal sinusitis or sinus tumors are suspected or need to be ruled out imaging studies like ultrasonography of the sinuses, CT scan or MRI scan of the sinuses may be prescribed. These also help detect anatomical abnormalities of the nose and sinuses. […] Conditions to be ruled out in diagnosing sinusitis (because they mimic symptoms of sinusitis) include allergic rhinitis, common cold, adenoiditis in children and other causes of headaches.

• #1 Acute Sinusitis – Harvard Health

  https://www.health.harvard.edu/a_to_z/acute-sinusitis-a-to-z

  Sinusitis is can be chronic (long-lasting or frequently returning) or acute. Acute sinusitis lasts three weeks or less and the person should have no more than three episodes per year. Acute sinusitis is extremely common. It usually is caused by an upper respiratory viral infection. […] A sinus infection can be difficult to diagnose in the early stages because it can mimic a common cold. Both can cause nasal congestion and fatigue. However, a common cold usually will improve in five to seven days, while an untreated sinus infection can last three weeks or longer. Sinus infections also are more likely to cause a green nasal discharge, fever and facial pain. […] Your doctor will diagnose acute sinusitis based on your symptoms, medical history and a simple office examination. The doctor will ask about your symptoms and how long they last, look into your ears, nose and throat, and may tap or press on your face to test for tenderness over specific sinuses.

• #1 Medical Management of Sinusitis | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/medical-management-sinusitis

  Uncomplicated acute rhinosinusitis requires no imaging studies. […] Acute rhinosinusitis is a self-limiting condition. A course of an antibiotic may decrease the length of symptoms. Antibiotics are not recommended for acute cases of viral rhinosinusitis. Antibiotics may be appropriate for cases of acute bacterial rhinosinusitis with symptoms present for 10 days after viral upper airway infection or worsening of symptoms after 5-7 days.

• #1 Acute Sinusitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15285-acute-sinusitis

  Acute sinusitis is an infection in your sinuses that typically lasts seven to 10 days. […] Acute sinusitis often goes away without prescription medication. […] Healthcare providers typically diagnose acute sinusitis by discussing your symptoms, including how long you’ve had them and if they’re getting worse. […] A provider will look at your ears, nose and throat for signs of swelling or drainage. […] A healthcare provider may prescribe antibiotics if you have acute sinusitis from a bacterial infection. Often, providers will take a wait-and-see approach before prescribing antibiotics. In general, acute sinusitis symptoms that last 10 or more days may be signs of bacterial infection.

• #1 It’s Not Just the Sniffles: Approach to Diagnosis and Management of Sinusitis in the Pediatric Population | Pediatric Emergency Medicine

  https://www.acep.org/pediatrics/education/education-articles/its-not-just-the-sniffles-approach-to-diagnosis-and-management-of-sinusitis-in-the-pediatric-population

  If the patient has significant nausea and vomiting and/or cannot tolerate oral antibiotics, a dose of either IV or IM 50 mg/kg Ceftriaxone can be given. Assuming the patient has improvement, oral antibiotic therapy can be initiated 24 hours following Ceftriaxone administration. […] Follow-up is of key importance in ABS and should occur within 72 hours following initial evaluation and initiation of therapy. If the patient fails to improve or has worsening of symptoms, the antibiotic should be changed (for example, transitioning from high dose Amoxicillin to Augmentin or a Cephalosporin). […] Patients with complicated ABS include those with any of the orbital, bony, or intracranial complications previously mentioned, and require admission and initiation of IV antibiotics.

• #1 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Preferred symptomatic therapy — For patients with ARS who do not have alarm symptoms, we suggest over-the-counter analgesics, antipyretics, and saline irrigation for symptomatic management. […] Systemic glucocorticoids not indicated — We suggest not using systemic glucocorticoids in the treatment of ARS. […] In patients with a clinical diagnosis of acute bacterial rhinosinusitis (ABRS), management options include an additional seven-day observation period or initiation of antibiotic therapy. […] For most patients with clinically diagnosed ABRS, we suggest an additional seven-day observation period without antibiotics (ie, „watchful waiting”). […] When observation is selected, we follow up with patients within seven days. If patients worsen during this period, or if they do not improve after seven days, we proceed to antibiotics.

• #1 Sinusitis

  https://www.aaaai.org/conditions-treatments/allergies/sinusitis

  Acute sinusitis refers to sinusitis symptoms lasting less than four weeks. Most cases begin as a common cold. Symptoms often go away within a week to 10 days; but in some people, a bacterial infection develops. […] Diagnosis Allergy testing performed by an allergist / immunologist can identify what allergic triggers might be behind your chronic or reoccurring sinus infections. […] Your doctor may order a MRI or CT scan to look for abnormalities in the sinuses narrow drainage passages, polyps or a deviated septum. […] Up to 70 % of people with acute sinusitis recover without any prescribed medications. If the cause is a bacterial infection, treatment with an antibiotic can shorten the duration of acute sinusitis and can also reduce the severity of symptoms.

• #1 Sinus Infection Basics | Sinus Infection | CDC

  https://www.cdc.gov/sinus-infection/about/index.html

  Your healthcare provider will determine if you have a sinus infection by asking about symptoms and examining you. […] You do not need antibiotics for many sinus infections. Most sinus infections usually get better on their own without antibiotics. […] However, in some cases, you may need antibiotics. Talk to your healthcare provider about the best treatment for your illness. […] For some sinus infections, your healthcare provider might recommend watchful waiting or delayed antibiotic prescribing. […] Your healthcare provider may suggest watching and waiting for 2-3 days to see if you need antibiotics. This gives the immune system time to fight off the infection. If your symptoms don’t improve, the healthcare provider may prescribe an antibiotic. […] Your healthcare provider may prescribe an antibiotic but suggest that you wait 2-3 days before filling the prescription. You may recover on your own and may not need the antibiotic.

• #1 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Antibiotic selection, when warranted, is discussed elsewhere. […] Patients who have worsening symptoms or do not improve with initial antibiotic therapy should have the diagnosis of ABRS confirmed with clinical reevaluation and imaging if needed; we suggest an alternative antibiotic regimen for patients with confirmed uncomplicated ABRS. […] Indications for otolaryngology referral — Patients who do not improve after multiple antibiotic courses, and those with recurrent infections, warrant referral to an otolaryngology specialist.

• #1 Sinusitis

  https://www.racgp.org.au/afp/2016/june/sinusitis

  Patients with acute viral rhinosinusitis should be treated with supportive therapies. These include regular analgesia, nasal saline irrigations and nasal decongestants. […] Routine use of antibiotics to treat ARS in primary care does not prevent the development of complications. […] Acute bacterial rhinosinusitis can be treated with antibiotics such as amoxicillin for five days. […] Immediate referral to an ear, nose and throat (ENT) specialist should occur if complications are suspected, as they can cause significant morbidity and mortality if left untreated. […] Diagnosis of sinusitis requires the presence of either nasal congestion or discharge. Facial pain is often misdiagnosed as sinusitis, but it is rarely a significant feature of chronic sinusitis. […] Treatment of CRS should commence with a trial of topical steroids and nasal irrigation for at least eight weeks.

• #1 Diagnosis and Management of Acute Rhinosinusitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7121979/

  Given that acute rhinosinusitis has such a high prevalence, it is imperative that health care providers are able to accurately diagnose the condition and appropriately prescribe antibiotics. […] The time-course of the symptoms then becomes the next most important factor in distinguishing VRS from ABRS. […] If symptoms initially improve and then subsequently worsen, or if symptoms persist beyond 10 days, the probability of bacterial infection is increased and the diagnosis of ABRS can be made. […] On physical examination, anterior rhinoscopy reveals hyperemia of the nasal mucosa and nasal congestion. If purulence is visualized the diagnosis is secured; pain on palpation over the individual sinuses may aid in the diagnosis. […] During evaluation for acute rhinosinusitis, associated factors must be considered.

• #1 02. Sinusitis | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/02-sinusitis/02-sinusitis

  Chronic rhinosinusitis: persistent symptoms lasting 12 weeks in duration. May have intermittent flare-ups. Role of bacteria more complex than in acute disease. Requires more complex workup including sinus CT, endoscopy, allergy evaluation and consideration of rheumatologic or immunologic causes. […] Labs/tests unnecessary in diagnosing ABRS. CT is valuable if concern for facial/orbital spread or structural precipitant. Role of culture discussed further in treatment section.

• #2 Acute rhinosinusitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/14?locale=th&

  Majority of cases of acute rhinosinusitis in adults and children are of viral aetiology. […] Duration of symptoms more than 10 days often indicates bacterial cause. […] Imaging is not required for diagnosis unless complications are suspected. […] Condition is usually self-limiting; however, symptomatic therapy should be considered. […] Antibiotics are only recommended in select patient groups (e.g., severe disease, persistent or worsening symptoms, or immunocompromised patients) because symptoms often resolve without intervention and there is a risk of antimicrobial resistance. […] Complications are uncommon and their risk alone should not result in antimicrobial prescribing. […] Acute rhinosinusitis (also commonly known as acute sinusitis) is a symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses, presenting with purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both for 4 weeks or less.

• #2 Clinical Diagnosis of Acute Bacterial Rhinosinusitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p758.html

  Which patients presenting with symptoms of acute rhinosinusitis have acute bacterial rhinosinusitis? […] Acute bacterial rhinosinusitis develops in only 0.5% to 2% of all upper respiratory tract infections. […] There is no consensus on the diagnostic criteria for acute bacterial rhinosinusitis. […] The American Academy of OtolaryngologyHead and Neck Surgery recommends diagnosing acute bacterial rhinosinusitis when symptoms or signs of acute rhinosinusitis (purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both) persist without evidence of improvement for at least 10 days after the onset of symptoms, or when symptoms or signs of acute rhinosinusitis worsen within 10 days of initial improvement or milder phase of illness (double sickening). […] In 2017, a clinical prediction rule was created for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis using 175 adult Danish patients in whom acute maxillary sinusitis was clinically suspected.

• #2 Diagnosis of Acute Sinusitis – ENT Health

  https://www.enthealth.org/be_ent_smart/diagnosis-of-acute-sinusitis/

  You have acute sinusitis when there has been up to 4 weeks of cloudy or colored (not clear) drainage from the nose plus one or both of the following: (a) a stuffy, congested, or blocked nose or (b) pain, pressure or fullness in the face, head, or around the eyes. […] Acute viral sinusitis is likely if you have been sick less than 10 days and are not getting worse. […] Acute bacterial sinusitis is likely when you do not improve at all within 10 days of getting sick or when you get worse within 10 days after beginning to get better. […] Because sinusitis is treated differently based on cause: acute viral sinusitis does not benefit from antibiotics, but some patients with acute bacterial sinusitis may get better faster with an antibiotic.

• #2 Diagnosis and Management of Acute Rhinosinusitis

  https://www.myprivia.com/greenvilleent/news/diagnosis-and-management-of-acute-rhinosinusitis

  A diagnosis of rhinosinusitis is probable if 2 or more major symptoms, or 1 major and 2 or more minor symptoms are present. […] If symptoms persist beyond 10 days, or if there is an acute worsening after 5 days, treatment should include an antibiotic prescribed by your doctor. […] Antibiotic course should be of 14 days duration to ensure complete response and avoid selection of resistant bacteria. […] Persistence of purulent drainage beyond 5 days after starting antibiotic therapy should trigger a return visit to the doctor. […] Any severe worsening of symptoms despite antibiotic therapy, such as facial or eye swelling, fever 102, or cognitive changes is a medical emergency. Patients should seek immediate medical attention, as these symptoms may represent a vision-threatening or life-threatening complication of sinusitis.

• #2 Sinus Infection (Sinusitis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17701-sinusitis

  Sinusitis is an inflammation of the tissues in your sinuses (spaces in your forehead, cheeks and nose usually filled with air). […] Sinusitis is an inflammation, or swelling, of the tissue lining your sinuses. […] We describe types of sinusitis based on how long its been going on (acute, subacute, chronic or recurrent) and whats causing it (bacteria, virus or fungus). […] Acute sinusitis symptoms (nasal congestion, drainage, facial pain/pressure and decreased sense of smell) last less than four weeks. Its usually caused by viruses like the common cold. […] If you have a runny nose, stuffy nose and facial pain that dont go away after ten days, you might have bacterial sinusitis. […] Healthcare providers diagnose sinusitis based on your symptoms and health history. […] Specific tests your provider might order to diagnose sinus infection include: Nasal endoscopy, Nasal swabs, Imaging, Allergy testing, Biopsy.

• #2 Diagnosis and Management of Acute Rhinosinusitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7121979/

  Given that acute rhinosinusitis has such a high prevalence, it is imperative that health care providers are able to accurately diagnose the condition and appropriately prescribe antibiotics. […] The time-course of the symptoms then becomes the next most important factor in distinguishing VRS from ABRS. […] If symptoms initially improve and then subsequently worsen, or if symptoms persist beyond 10 days, the probability of bacterial infection is increased and the diagnosis of ABRS can be made. […] On physical examination, anterior rhinoscopy reveals hyperemia of the nasal mucosa and nasal congestion. If purulence is visualized the diagnosis is secured; pain on palpation over the individual sinuses may aid in the diagnosis. […] During evaluation for acute rhinosinusitis, associated factors must be considered.

• #2 Acute Sinusitis: Causes, Symptoms & Diagnosis

  https://www.healthline.com/health/acute-sinusitis

  Diagnosing acute sinusitis usually involves a physical exam. Your doctor will gently press over your sinuses with their fingers to identify an infection. The exam may involve looking into your nose with a light to identify inflammation, polyps, tumors, or other abnormalities. Your doctor may also take a culture to help diagnose. […] Your doctor may also perform the following tests to confirm a diagnosis: […] Your doctor may look into your nose using a nasal endoscope. This is a thin, flexible fiber-optic scope. The scope helps your doctor identify inflammation or other abnormalities in your sinuses. […] Your doctor may order a CT scan or MRI to look for inflammation or other nose or sinus abnormalities. A CT scan uses rotating X-rays and computers to take detailed, cross-sectional images of your body. An MRI takes 3-D images of your body using radio waves and a magnetic field. Both these tests are noninvasive.

• #2 Do imaging studies aid diagnosis of acute sinusitis? | MDedge

  https://community.the-hospitalist.org/content/do-imaging-studies-aid-diagnosis-acute-sinusitis

  Accurate diagnosis of acute sinusitis in both children and adults depends on the history and clinical examination of the patient. […] There is no role for imaging in the diagnosis of acute sinusitis. […] In the absence of a clear diagnosis of acute sinusitis, antibiotics are very unlikely to improve symptoms and are, therefore, not indicated. […] Though the sensitivity and specificity of a clinical evaluation possibly could be enhanced with the use of imaging studies, diagnostic accuracy of acute disease is not sufficiently improved to justify the cost or inconvenience of such interventions. […] In a guideline on appropriate antibiotic use in sinusitis, radiography is not recommended for the diagnosis of acute sinusitis. […] The guideline recommends that clinicians rely on duration of illness (at least 7 days) and severity of symptoms to make an accurate diagnosis of sinusitis.

• #2 Medical Treatment for Acute Sinusitis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/861646-workup

  Some authors have reported on the use of laboratory tests, including sedimentation rates, white blood cell counts, and C-reactive protein levels, to help diagnose acute sinusitis. These tests appear to add little to the predictive value of clinical findings in the diagnosis. […] Cultures are not routinely obtained in the evaluation of acute sinusitis but should be obtained in a patient in intensive care or with immunocompromise, in children not responding to appropriate medical management, and in patients with complications of sinusitis. […] Imaging studies are not necessary when the probability of sinusitis is either high or low but may be useful when the diagnosis is in doubt, based upon a thorough history and physical examination. […] CT scanning has poor specificity for the diagnosis of acute sinusitis, demonstrating sinus air-fluid levels in 87% of individuals with simple URTIs and 40% of asymptomatic individuals. […] Magnetic resonance imaging (MRI) is excellent for evaluating soft tissue disease within the sinuses, but it is of little value in the diagnostic workup for acute sinusitis.

• #2 Acute maxillary sinusitis | Evidence-Based Medicine Guidelines

  https://evidence.unboundmedicine.com/evidence/view/EBMG/452788/all/Acute_maxillary_sinusitis

  Diagnosis of acute sinusitis requires clinical examination of the nose and pharynx, in particular. Purulent secretions in the middle nasal meatus, nasopharynx or on the posterior wall of the pharynx suggests bacterial sinusitis. […] Ultrasonography is a relatively reliable diagnostic method in adults and teenagers but requires training and practice. […] Laboratory investigations are usually not needed for the diagnosis of acute sinusitis. However, in patients with severe symptoms, laboratory investigations (basic blood count with platelet count, CRP) may be necessary to confirm bacterial infection (also other than sinusitis).

• #2

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  CT scanning of the sinuses is the imaging procedure of choice. […] The most accurate way to determine the causative organism in sinusitis is a sinus puncture. After anesthetization of the puncture site, usually in the canine fossa or inferior meatus, the contents of the maxillary sinus are aspirated under sterile technique, and bacterial cultures are performed to identify the organism. […] The antibiotic of choice for acute sinusitis must cover S. pneumoniae, H. influenzae, and M. catarrhalis. […] The presence of purulent secretions has the highest positive predictive value for clinically diagnosing sinusitis. […] If medical therapy fails or if complications are suspected, an otolaryngology consultation is warranted.

• #2 UC Davis Health | Department of Otolaryngology | Diagnosis of Sinusitis

  https://health.ucdavis.edu/otolaryngology/specialty/sinus-center/diagnosis-of-sinusitis.html

  The symptoms of sinusitis are not unique to the disease itself. Other disease processes can mimic sinusitis including the common cold, allergies, migraine headache, chronic daily headache, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea. Therefore an accurate diagnosis requires a thorough history and physical examination. This will document the timing, duration, severity of the symptoms, what interventions have previously been performed and the success of each. […] Nasal endoscopy is also used to make the diagnosis of sinusitis. This procedure involves passing a fiber-optic telescope, or „endoscope,” into the nose and examining the interior of the nasal cavity. […] While nasal endoscopy plays a major role in the diagnosis of sinusitis, this procedure can only give information about the openings of the sinuses (unless the patient has had previous surgery to widen the natural openings). Therefore another tool, called computerized tomography or a CT scan, is used to visualize the sinus interior. The CT scan provides information about swelling within the sinuses and also provides a road map of sinus anatomy should surgery be necessary.

• #2 Sinusitis

  https://www.racgp.org.au/afp/2016/june/sinusitis

  In the event that appropriate medical therapy fails, patients should be referred to an otorhinolaryngologist for consideration of surgical management. The current surgical approach to CRS is functional endoscopic sinus surgery (FESS). […] It is important for patients to be aware that CRS is an inflammatory condition of the mucosa, and that as such, sinus surgery is not a cure for their condition; rather, it is an attempt to allow better symptom control.

• #2 Rhinosinusitis and the role of imaging | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/8/485

  In patients with a history of recurrent or chronic sinusitis who have had imaging in the past, in the absence of new symptoms, imaging does not provide further information and findings often remain unchanged. Repeat imaging is not necessary unless clinical signs or symptoms have changed. […] Imaging is not routinely recommended in patients who present with symptoms of allergic rhinitis. When patients present with symptoms of rhinosinusitis (as opposed to rhinitis, which affects only the nasal cavity), signs of complicated infections, signs of neoplasm, or persistence of symptoms and chronic rhinosinusitis, imaging may be warranted. […] Acute, uncomplicated rhinosinusitis remains a clinical diagnosis. Imaging should only be used in the case of complicated sinus infections, recurrent or chronic sinus disease, or in the case of surgical planning.

• #3 UC Davis Health | Department of Otolaryngology | Diagnosis of Sinusitis

  https://health.ucdavis.edu/otolaryngology/specialty/sinus-center/diagnosis-of-sinusitis.html

  The symptoms of sinusitis are not unique to the disease itself. Other disease processes can mimic sinusitis including the common cold, allergies, migraine headache, chronic daily headache, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea. Therefore an accurate diagnosis requires a thorough history and physical examination. This will document the timing, duration, severity of the symptoms, what interventions have previously been performed and the success of each. […] Nasal endoscopy is also used to make the diagnosis of sinusitis. This procedure involves passing a fiber-optic telescope, or „endoscope,” into the nose and examining the interior of the nasal cavity. […] While nasal endoscopy plays a major role in the diagnosis of sinusitis, this procedure can only give information about the openings of the sinuses (unless the patient has had previous surgery to widen the natural openings). Therefore another tool, called computerized tomography or a CT scan, is used to visualize the sinus interior. The CT scan provides information about swelling within the sinuses and also provides a road map of sinus anatomy should surgery be necessary.

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