Przewlekłe zapalenie zatok
Rokowania, prognozy i postęp choroby
Przewlekłe zapalenie zatok przynosowych (CRS) jest schorzeniem o wieloczynnikowej etiologii, obejmującym czynniki infekcyjne, zapalne i strukturalne, dotykającym około 10% dorosłych w krajach rozwiniętych. Leczenie CRS wymaga wczesnej i agresywnej terapii medycznej, a w przypadkach opornych na leczenie zachowawcze, funkcjonalna endoskopowa chirurgia zatok (FESS) przynosi całkowitą lub umiarkowaną ulgę u 80-90% pacjentów. Kluczowymi predyktorami sukcesu operacyjnego są brak wcześniejszych zabiegów chirurgicznych oraz wysokie wyniki w skali SNOT-22, gdzie objawy takie jak katar nosa korelują z lepszą odpowiedzią na zabieg, natomiast smutek i kaszel z gorszą. Wartości statystyczne wskazują, że pacjenci poddawani pierwszej operacji mają 2,1 razy większą szansę na poprawę w skali RSDI (95% CI: 1,2-3,4; p=0,006) oraz 1,8 razy większą szansę na poprawę w skali CSS (95% CI: 1,1-3,1; p=0,020) w porównaniu do operacji rewizyjnej.
- Przewidywanie wyników leczenia przewlekłego zapalenia zatok
- Ogólne czynniki wpływające na rokowanie
- Przewidywanie wyników leczenia chirurgicznego
- Kwestionariusz SNOT-22 jako predyktor poprawy po operacji
- Rokowanie w CRSwNP i CRSsNP
- Powikłania i wpływ na jakość życia
- Przewidywanie odpowiedzi na leczenie
- Poprawa wyników leczenia przewlekłego zapalenia zatok
Przewidywanie wyników leczenia przewlekłego zapalenia zatok
Przewlekłe zapalenie zatok przynosowych (CRS) to powszechna choroba, dotykająca około 10% dorosłych w Wielkiej Brytanii i podobny odsetek w innych krajach rozwiniętych. Jest to schorzenie wieloczynnikowe, obejmujące czynniki infekcyjne, zapalne oraz strukturalne, które może znacząco wpływać na jakość życia pacjentów, jeśli nie jest odpowiednio leczone.1 Określenie prawdopodobnego wyniku leczenia (rokowania) ma kluczowe znaczenie w planowaniu terapii i oczekiwań pacjenta. Przewlekłe zapalenie zatok przynosowych, ze względu na swój długotrwały charakter, często nie poddaje się szybkiemu wyleczeniu, co może powodować frustrację pacjentów.2
Ogólne czynniki wpływające na rokowanie
Przy odpowiednim leczeniu, większość pacjentów z przewlekłym zapaleniem zatok przynosowych może uzyskać dobrą kontrolę objawów i zadowalającą jakość życia.3 Wczesne i agresywne leczenie medyczne zwykle przynosi zadowalające rezultaty, podczas gdy funkcjonalna endoskopowa chirurgia zatok (FESS) przywraca zdrowie zatok z całkowitą lub umiarkowaną ulgą objawów u 80-90% pacjentów z nawracającym lub opornym na leczenie zachowawcze przewlekłym zapaleniem zatok.4
Choć przewlekłe zapalenie zatok rzadko zagraża życiu, poważne powikłania mogą występować ze względu na bliskie sąsiedztwo oczodołu i jamy czaszki. Około 75% wszystkich infekcji oczodołowych jest bezpośrednio związanych z zapaleniem zatok. Powikłania wewnątrzczaszkowe pozostają stosunkowo rzadkie, z 3,7% do 10% infekcji wewnątrzczaszkowych mających związek z zapaleniem zatok.5
Przewidywanie wyników leczenia chirurgicznego
Badania wieloośrodkowe wykazały, że większość pacjentów doświadcza klinicznie istotnej poprawy jakości życia (QOL) po endoskopowej chirurgii zatok (ESS). Określone cechy pacjenta mają wartość prognostyczną w odniesieniu do wyników leczenia.6
Jednym z najważniejszych predyktorów sukcesu leczenia operacyjnego jest historia wcześniejszych zabiegów chirurgicznych. Pacjenci poddawani pierwszej operacji zatok mają 2,1 razy większą szansę na poprawę w skali RSDI (Rhinosinusitis Disability Index) (95% CI: 1,2, 3,4; p=0,006) oraz 1,8 razy większą szansę na poprawę w skali CSS (Chronic Sinusitis Survey) (95% CI: 1,1, 3,1; p=0,020) w porównaniu do pacjentów poddawanych operacji rewizyjnej.78
W analizie wielowymiarowej, po uwzględnieniu wieku i płci, tylko historia wcześniejszej operacji zatok przewidywała wyniki: pacjenci poddawani pierwotnej operacji zatok mieli 2,1 razy większą szansę na poprawę niż pacjenci poddawani operacji rewizyjnej (95% CI: 1,2, 3,4; p=0,006).9
Kwestionariusz SNOT-22 jako predyktor poprawy po operacji
Test wyniku sino-nosowego (SNOT-22) okazał się cennym narzędziem w przewidywaniu poprawy po operacji u pacjentów z przewlekłym zapaleniem zatok. Pacjenci z najwyższymi wynikami objawów doświadczają największego stopnia poprawy objawów po zabiegu.10
Analiza wieloczynnikowa wykazała, które poszczególne komponenty SNOT-22 dostarczają unikalnych informacji prognostycznych dotyczących wyników operacji:
- Katar z nosa przewidywał większą poprawę objawów po operacji
- Smutek i kaszel były znaczącymi predyktorami mniejszej poprawy po operacji
Spośród wszystkich ocenianych czynników demograficznych, tylko wcześniejsza operacja przewidywała wielkość poprawy, przy czym największą bezwzględną poprawę obserwowano u osób bez wcześniejszej operacji. Sugeruje to, że pierwsza próba interwencji chirurgicznej jest niezwykle ważna.1314
Rokowanie w CRSwNP i CRSsNP
Długoterminowe wyniki u pacjentów z przewlekłym zapaleniem zatok przynosowych bez polipów nosowych (CRSsNP) są słabo zbadane. Utworzono międzynarodowy rejestr w celu gromadzenia danych na temat naturalnej historii zaburzenia i wyników leczenia.15
W przypadku przewlekłego zapalenia zatok przynosowych z polipami nosowymi (CRSwNP) nie ma znanego lekarstwa, a długoterminowe wyniki są również słabo zbadane. Wielu pacjentów wymaga bezterminowego leczenia.16
Nowe terapie biologiczne, takie jak dupilumab, znacząco poprawiają subiektywne i obiektywne wyniki CRSwNP. Badania wykazały korelacje między względnymi zmianami w wyniku SNOT a skalą polipów nosowych (NPS), co ma wartość predykcyjną. Stratyfikacja wyników według wyjściowego NPS ujawnia korelacje i dostarcza dowodów na możliwość przewidywania odpowiedzi na leczenie.17
Powikłania i wpływ na jakość życia
Przewlekłe zapalenie zatok może stać się znaczącą przyczyną chorobowości. Jeśli pozostaje nieleczone, może obniżyć jakość życia i produktywność dotkniętej osoby. Jest związane z zaostrzeniem astmy i poważnymi powikłaniami, takimi jak ropień mózgu i zapalenie opon mózgowych, które mogą powodować znaczącą chorobowość i śmiertelność.18
Przewlekłe powikłania są zwykle wtórne do stałej obecności śluzu i/lub polipów w jamie nosowej i zatokach przynosowych i mogą obejmować częściową lub całkowitą utratę zmysłu węchu. Niedrożność nosa i zapalenie nerwu węchowego mogą powodować czasową lub trwałą utratę zmysłu węchu.19
Przewidywanie odpowiedzi na leczenie
Przewidywanie, którzy pacjenci odniosą korzyści z antybiotykoterapii, pozostaje wyzwaniem klinicznym. Badania wykazały, że tygodniowy wyciek ropny nie ma wartości predykcyjnej dla odpowiedzi na antybiotyki. Istnieje potrzeba opracowania bardziej kompleksowego algorytmu uwzględniającego objawy, szczegółową historię, biomarkery i wyniki hodowli w celu efektywnego kosztowo wykorzystania wszystkich tych narzędzi.20
Wyniki leczenia można definiować na różne sposoby, np. jako moment, gdy pacjent wskazuje w swoim dzienniku, że czuje się znowu ogólnie dobrze, lub jako ustąpienie objawów, które pacjent zidentyfikował jako najbardziej wpływające na jego zdrowie na początku badania.21
Poprawa wyników leczenia przewlekłego zapalenia zatok
Funkcjonalna endoskopowa chirurgia zatok (FESS) zapewnia możliwość otwarcia okien do zatok, które wcześniej nie istniały, poprawiając tym samym stosowanie pooperacyjnych zabiegów medycznych, w tym sterydów. Przy optymalnej interwencji chirurgicznej (i pooperacyjnym postępowaniu medycznym), FESS jest niezwykle skutecznym leczeniem przewlekłego zapalenia zatok przynosowych.22
Lepsza skoordynowana opieka między podstawową opieką zdrowotną a ośrodkami specjalistycznymi oraz spójność porad mają potencjał zwiększenia satysfakcji pacjenta i poprawy wyników leczenia. Ze względu na długotrwały charakter choroby, pacjenci są często sfrustrowani swoim leczeniem, a słaba komunikacja może prowadzić do opóźnień w otrzymywaniu odpowiedniego leczenia i terminowego skierowania do specjalisty.23
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Materiały źródłowe
- #1 Sinusitis | Doctorhttps://patient.info/doctor/sinusitis-pro
Chronic sinusitis is multifactorial in nature and can include infectious, inflammatory, or structural factors. […] Chronic sinusitis is a common condition, affecting 1 in 10 UK adults. […] By its nature, this is a long-term problem which does not lend itself to rapid cure. Patients are often frustrated with their management, and poor communication can result in delays in receiving appropriate treatment and timely referral. Better coordinated care between general practice and specialist settings and consistency of advice have the potential to increase patient satisfaction and improve outcomes.
- #2 Sinusitis | Doctorhttps://patient.info/doctor/sinusitis-pro
Chronic sinusitis is multifactorial in nature and can include infectious, inflammatory, or structural factors. […] Chronic sinusitis is a common condition, affecting 1 in 10 UK adults. […] By its nature, this is a long-term problem which does not lend itself to rapid cure. Patients are often frustrated with their management, and poor communication can result in delays in receiving appropriate treatment and timely referral. Better coordinated care between general practice and specialist settings and consistency of advice have the potential to increase patient satisfaction and improve outcomes.
- #3 Prognosis for Rhinosinusitishttps://www.clinicbarcelona.org/en/assistance/diseases/rhinosinusitis/evolution-of-the-disease
Chronic rhinosinusitis, treatment generally achieves good control over the symptoms and patients can have a good quality of life. […] Chronic complications are usually secondary to the constant presence of mucus and/or polyps in the nasal cavity and paranasal sinuses. […] Partial or total loss of the sense of smell. Nasal obstruction and inflammation of the nerve of smell (olfactory nerve) can cause a temporary or permanent loss of the sense of smell.
- #4 Chronic Sinusitis: Practice Essentials, Background, Anatomyhttps://emedicine.medscape.com/article/232791-overview
Chronic sinusitis can become a significant cause of morbidity. […] If left untreated, it can reduce the quality of life and the productivity of the affected person. […] Chronic sinusitis is associated with exacerbation of asthma and serious complications such as brain abscess and meningitis, which can produce significant morbidity and mortality. […] Early and aggressive medical treatment for chronic sinusitis typically results in satisfactory outcomes. […] Functional endoscopic sinus surgery (FESS) restores sinus health with complete or moderate relief of symptoms in 80% to 90% of patients with recurrent or medically unresponsive chronic sinusitis. […] Chronic sinusitis rarely is life threatening, although serious complications can occur because of the proximity to the orbit and cranial cavity. […] Approximately 75% of all orbital infections are directly related to sinusitis. […] Intracranial complications remain comparatively rare, with 3.7% to 10% of intracranial infections related to sinusitis.
- #5 Chronic Sinusitis: Practice Essentials, Background, Anatomyhttps://emedicine.medscape.com/article/232791-overview
Chronic sinusitis can become a significant cause of morbidity. […] If left untreated, it can reduce the quality of life and the productivity of the affected person. […] Chronic sinusitis is associated with exacerbation of asthma and serious complications such as brain abscess and meningitis, which can produce significant morbidity and mortality. […] Early and aggressive medical treatment for chronic sinusitis typically results in satisfactory outcomes. […] Functional endoscopic sinus surgery (FESS) restores sinus health with complete or moderate relief of symptoms in 80% to 90% of patients with recurrent or medically unresponsive chronic sinusitis. […] Chronic sinusitis rarely is life threatening, although serious complications can occur because of the proximity to the orbit and cranial cavity. […] Approximately 75% of all orbital infections are directly related to sinusitis. […] Intracranial complications remain comparatively rare, with 3.7% to 10% of intracranial infections related to sinusitis.
- #6 Determinants of Outcomes of Sinus Surgery: A Multi-Institutional Prospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2815335/
In this prospective, multi-institutional study, most patients experienced clinically significantly improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes. […] Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% CI: 1.2, 3.4; p=0.006) and 1.8 times more likely to improve on the CSS (95% CI: 1.1, 3.1; p=0.020) as compared to patients undergoing revision surgery. […] The first multivariate logistic regression model examined predictors of clinically significant improvement on the RSDI. After adjustment for age and gender, only a history of prior sinus surgery predicted outcomes: patients undergoing primary sinus surgery were 2.1 times as likely to improve as patients undergoing revision sinus surgery (95% CI: 1.2, 3.4; p=0.006).
- #7 Determinants of Outcomes of Sinus Surgery: A Multi-Institutional Prospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2815335/
In this prospective, multi-institutional study, most patients experienced clinically significantly improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes. […] Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% CI: 1.2, 3.4; p=0.006) and 1.8 times more likely to improve on the CSS (95% CI: 1.1, 3.1; p=0.020) as compared to patients undergoing revision surgery. […] The first multivariate logistic regression model examined predictors of clinically significant improvement on the RSDI. After adjustment for age and gender, only a history of prior sinus surgery predicted outcomes: patients undergoing primary sinus surgery were 2.1 times as likely to improve as patients undergoing revision sinus surgery (95% CI: 1.2, 3.4; p=0.006).
- #8 Determinants of Outcomes of Sinus Surgery: A Multi-Institutional Prospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2815335/
The second multivariate logistic regression model examined predictors of clinically significant improvement on the CSS. After adjustment for age and gender, a history of prior sinus surgery predicted less improvement in QOL after ESS. Patients undergoing primary sinus surgery were 1.8 times as likely to improve as patients undergoing revision sinus surgery (95% CI: 1.1, 3.1; p=0.020).
- #9 Determinants of Outcomes of Sinus Surgery: A Multi-Institutional Prospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2815335/
In this prospective, multi-institutional study, most patients experienced clinically significantly improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes. […] Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% CI: 1.2, 3.4; p=0.006) and 1.8 times more likely to improve on the CSS (95% CI: 1.1, 3.1; p=0.020) as compared to patients undergoing revision surgery. […] The first multivariate logistic regression model examined predictors of clinically significant improvement on the RSDI. After adjustment for age and gender, only a history of prior sinus surgery predicted outcomes: patients undergoing primary sinus surgery were 2.1 times as likely to improve as patients undergoing revision sinus surgery (95% CI: 1.2, 3.4; p=0.006).
- #10 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
In this study, we have provided further corroboration of previously identified prognostic factors and identified additional factors that inform the optimal selection of patients for FESS. […] The value of the overall SNOT-22 score was apparent with patients with the highest symptom scores experiencing the greatest degree of symptom improvement. […] Via multivariate analysis it was revealed which individual components of the SNOT-22 provided unique information predictive of surgical outcomes. […] Multiple regression analysis of the significant factors yielded the interesting observation that runny nose predicted greater improvement in symptoms, while sadness and cough were significantly predictive of lesser improvement. […] Of all the evaluated demographic factors, only prior surgery was predictive of the magnitude of improvement, with the greatest absolute improvement seen in those with no prior surgery.
- #11 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
In this study, we have provided further corroboration of previously identified prognostic factors and identified additional factors that inform the optimal selection of patients for FESS. […] The value of the overall SNOT-22 score was apparent with patients with the highest symptom scores experiencing the greatest degree of symptom improvement. […] Via multivariate analysis it was revealed which individual components of the SNOT-22 provided unique information predictive of surgical outcomes. […] Multiple regression analysis of the significant factors yielded the interesting observation that runny nose predicted greater improvement in symptoms, while sadness and cough were significantly predictive of lesser improvement. […] Of all the evaluated demographic factors, only prior surgery was predictive of the magnitude of improvement, with the greatest absolute improvement seen in those with no prior surgery.
- #12 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
This finding suggests that the first attempt at surgical intervention is extremely important. […] Importantly, FESS provides the opportunity to open windows into the sinuses that did not previously exist, thereby improving the application of post-operative medical treatments, including steroids. […] In conclusion, our study showed that, with optimal surgical intervention (and post-operative medical management), FESS is an extremely effective treatment of CRS. […] While all of the components of the SNOT-22 significantly improved after surgery, only runny nose (associated with greater improvement), as well as cough and sadness (both associated with less improvement) were independent predictors of post-surgical SNOT-22 improvement.
- #13 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
In this study, we have provided further corroboration of previously identified prognostic factors and identified additional factors that inform the optimal selection of patients for FESS. […] The value of the overall SNOT-22 score was apparent with patients with the highest symptom scores experiencing the greatest degree of symptom improvement. […] Via multivariate analysis it was revealed which individual components of the SNOT-22 provided unique information predictive of surgical outcomes. […] Multiple regression analysis of the significant factors yielded the interesting observation that runny nose predicted greater improvement in symptoms, while sadness and cough were significantly predictive of lesser improvement. […] Of all the evaluated demographic factors, only prior surgery was predictive of the magnitude of improvement, with the greatest absolute improvement seen in those with no prior surgery.
- #14 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
This finding suggests that the first attempt at surgical intervention is extremely important. […] Importantly, FESS provides the opportunity to open windows into the sinuses that did not previously exist, thereby improving the application of post-operative medical treatments, including steroids. […] In conclusion, our study showed that, with optimal surgical intervention (and post-operative medical management), FESS is an extremely effective treatment of CRS. […] While all of the components of the SNOT-22 significantly improved after surgery, only runny nose (associated with greater improvement), as well as cough and sadness (both associated with less improvement) were independent predictors of post-surgical SNOT-22 improvement.
- #15 Chronic rhinosinusitis with nasal polyposis: Management and prognosis – UpToDatehttps://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
PROGNOSIS […] Long-term outcomes in patients with CRSsNP are poorly studied. An international registry has been established to collect data on the natural history of the disorder and treatment outcomes. […] […] […] There is no known cure for CRSwNP, and long-term outcomes are poorly studied. Many patients require indefinite treatment.
- #16 Chronic rhinosinusitis with nasal polyposis: Management and prognosis – UpToDatehttps://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
PROGNOSIS […] Long-term outcomes in patients with CRSsNP are poorly studied. An international registry has been established to collect data on the natural history of the disorder and treatment outcomes. […] […] […] There is no known cure for CRSwNP, and long-term outcomes are poorly studied. Many patients require indefinite treatment.
- #17https://link.springer.com/article/10.1007/s00405-024-08973-7
Dupilumab therapy significantly improved subjective and objective CRSwNP scores, exhibiting weak correlations in absolute values for nasal subscores. […] Furthermore, evidence indicated a correlation between relative changes in SNOT score and NPS, substantiated by predictive capability. […] In summary, stratifying the scores by baseline NPS reveals correlations and even yields evidence of predictive capability.
- #18 Chronic Sinusitis: Practice Essentials, Background, Anatomyhttps://emedicine.medscape.com/article/232791-overview
Chronic sinusitis can become a significant cause of morbidity. […] If left untreated, it can reduce the quality of life and the productivity of the affected person. […] Chronic sinusitis is associated with exacerbation of asthma and serious complications such as brain abscess and meningitis, which can produce significant morbidity and mortality. […] Early and aggressive medical treatment for chronic sinusitis typically results in satisfactory outcomes. […] Functional endoscopic sinus surgery (FESS) restores sinus health with complete or moderate relief of symptoms in 80% to 90% of patients with recurrent or medically unresponsive chronic sinusitis. […] Chronic sinusitis rarely is life threatening, although serious complications can occur because of the proximity to the orbit and cranial cavity. […] Approximately 75% of all orbital infections are directly related to sinusitis. […] Intracranial complications remain comparatively rare, with 3.7% to 10% of intracranial infections related to sinusitis.
- #19 Prognosis for Rhinosinusitishttps://www.clinicbarcelona.org/en/assistance/diseases/rhinosinusitis/evolution-of-the-disease
Chronic rhinosinusitis, treatment generally achieves good control over the symptoms and patients can have a good quality of life. […] Chronic complications are usually secondary to the constant presence of mucus and/or polyps in the nasal cavity and paranasal sinuses. […] Partial or total loss of the sense of smell. Nasal obstruction and inflammation of the nerve of smell (olfactory nerve) can cause a temporary or permanent loss of the sense of smell.
- #20 Predicting Prognosis and Effect of Antibiotic Treatment in Rhinosinusitis | Annals of Family Medicinehttps://www.annfammed.org/content/4/6/486/tab-e-letters
The purpose of our study was different from the study of van Duyn. van Duyn looked for clinical symptoms predicting the presence of fluid in the maxillary sinuses on ultrasonography. We looked for clinical symptoms predicting the prognosis or effect of antibiotics. The presence of fluid in the sinuses does not necessarily mean that there is a bacterial infection that will respond to antibiotics or influence the prognosis. […] De Sutters study reinforces the clinical difficulty in differentiating viral from bacterial infection. It clearly shows that 1 week of purulent drainage doesnt have predictive value for response to antibiotics. Unfortunately, it didnt study, as a distinct group, the 3 or more signs and symptoms that together have been shown to have predictive accuracy. […] The outcome in the present study is defined as the patient indicated in his or her diary feeling generally well again as noted in the diary. This outcome differs from the outcomes studied in the original clinical trial which used the disappearance of symptoms that the patient identified as most greatly affecting their health at baseline. […] It seems there may be no magic bullets in predicting who needs a prescription. Hopefully, in the near future, an algorithm tree incorporating signs and symptoms, detailed history, biomarkers, and culture can be developed to make use of all these tools in a cost-effective manner.
- #21 Predicting Prognosis and Effect of Antibiotic Treatment in Rhinosinusitis | Annals of Family Medicinehttps://www.annfammed.org/content/4/6/486/tab-e-letters
The purpose of our study was different from the study of van Duyn. van Duyn looked for clinical symptoms predicting the presence of fluid in the maxillary sinuses on ultrasonography. We looked for clinical symptoms predicting the prognosis or effect of antibiotics. The presence of fluid in the sinuses does not necessarily mean that there is a bacterial infection that will respond to antibiotics or influence the prognosis. […] De Sutters study reinforces the clinical difficulty in differentiating viral from bacterial infection. It clearly shows that 1 week of purulent drainage doesnt have predictive value for response to antibiotics. Unfortunately, it didnt study, as a distinct group, the 3 or more signs and symptoms that together have been shown to have predictive accuracy. […] The outcome in the present study is defined as the patient indicated in his or her diary feeling generally well again as noted in the diary. This outcome differs from the outcomes studied in the original clinical trial which used the disappearance of symptoms that the patient identified as most greatly affecting their health at baseline. […] It seems there may be no magic bullets in predicting who needs a prescription. Hopefully, in the near future, an algorithm tree incorporating signs and symptoms, detailed history, biomarkers, and culture can be developed to make use of all these tools in a cost-effective manner.
- #22 Sino-nasal Outcome Test (SNOT-22): A predictor of post-surgical improvement in patients with chronic sinusitishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3977600/
This finding suggests that the first attempt at surgical intervention is extremely important. […] Importantly, FESS provides the opportunity to open windows into the sinuses that did not previously exist, thereby improving the application of post-operative medical treatments, including steroids. […] In conclusion, our study showed that, with optimal surgical intervention (and post-operative medical management), FESS is an extremely effective treatment of CRS. […] While all of the components of the SNOT-22 significantly improved after surgery, only runny nose (associated with greater improvement), as well as cough and sadness (both associated with less improvement) were independent predictors of post-surgical SNOT-22 improvement.
- #23 Sinusitis | Doctorhttps://patient.info/doctor/sinusitis-pro
Chronic sinusitis is multifactorial in nature and can include infectious, inflammatory, or structural factors. […] Chronic sinusitis is a common condition, affecting 1 in 10 UK adults. […] By its nature, this is a long-term problem which does not lend itself to rapid cure. Patients are often frustrated with their management, and poor communication can result in delays in receiving appropriate treatment and timely referral. Better coordinated care between general practice and specialist settings and consistency of advice have the potential to increase patient satisfaction and improve outcomes.