The diagnosis and management of sinusitis: A practice parameter update

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These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “The diagnosis and management of sinusitis: a practice parameter update.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

Section snippets

Contributors

The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions is made subsequently.

Chief editors

Raymond G. Slavin, MD

Departments of Internal Medicine, Molecular Microbiology and Immunology

Saint Louis University, Health Science Center

St Louis, Missouri

Sheldon L. Spector, MD

Department of Medicine

UCLA School of Medicine

Director, California Allergy & Asthma Medical Group

Los Angeles, California

I. Leonard Bernstein, MD

Department of Medicine and Environmental Health

University of Cincinnati College of Medicine

Cincinnati, Ohio

Workgroup members

Michael A. Kaliner, MD

Department of Medicine

George Washington University School of Medicine

Washington, DC

David W. Kennedy, MD

Rhinology Professor and Vice Dean

University of Pennsylvania Medical Center

Philadelphia, Pennsylvania

Frank S. Virant, MD

Department of Pediatrics

University of Washington

Seattle, Washington

Ellen R. Wald, MD

Department of Pediatrics

University of Pittsburgh School of Medicine

Chief, Division of Allergy, Immunology and Infectious Diseases

Pittsburgh, Pennsylvania

Joint task force reviewers

David A. Khan, MD

Department of Internal Medicine

University of Texas Southwestern Medical Center

Dallas, Texas

Joann Blessing-Moore, MD

Departments of Medicine and Pediatrics

Stanford University Medical Center

Department of Immunology

Stanford, California

David M. Lang, MD

Allergy/Immunology Section

Division of Medicine

Director, Allergy and Immunology Fellowship Training Program

Cleveland Clinic Foundation

Cleveland, Ohio

Richard A. Nicklas, MD

Department of Medicine

George Washington Medical Center

Reviewers

Larry Borish, MD, Charlottesville, Virginia

Robert A. Nathan, MD, Colorado Springs, Colorado

Brian A. Smart, MD, Chicago, Illinois

Mark L. Vandewalker, MD, Columbia, Missouri

Category of evidence

  • Ia

    Evidence from meta-analysis of randomized controlled trials

  • Ib

    Evidence from at least one randomized controlled trial

  • IIa

    Evidence from at least one controlled study without randomization

  • IIb

    Evidence from at least one other type of quasiexperimental study

  • III

    Evidence from nonexperimental descriptive studies, such as comparative studies

  • IV

    Evidence from expert committee reports or opinions, clinical experience of respected authorities, or both

Strength of recommendation

  • A

    Directly based on category I evidence

  • B

    Directly based on category II

Preface

Sinusitis is one of the most commonly diagnosed diseases in the United States, affecting an estimated 16% of the adult population annually. It extracts an overall direct annual health care cost of $5.8 billion. Total restricted activity days increased from 50 million per year during 1986 through 1988 to 73 million per year during 1990 through 1992.1 Sinusitis also significantly affects quality of life in some symptom domains even more than other chronic diseases, such as chronic obstructive

Executive summary

Sinusitis, defined as inflammation of one or more of the paranasal sinuses, is characterized as acute when lasting less than 4 weeks, subacute when lasting 4 to 8 weeks, and chronic when lasting longer than 8 weeks. Recurrent sinusitis consists of 3 or more episodes of acute sinusitis per year. A noninfectious form of chronic sinusitis is termed chronic hyperplastic eosinophilic sinusitis. Viral upper respiratory tract infections frequently precede subsequent bacterial invasion of the sinuses

Annotations to the algorithm

  • 1.

    Symptoms suggestive of acute sinusitis

    • Acute sinusitis typically presents as a persistent upper respiratory tract infection (10-14 days without improvement).

    • In adults prominent symptoms include nasal congestion, purulent rhinorrhea, postnasal drainage, facial or dental pain, headache, and cough, frequently with a more severe nocturnal component.

    • Any patient with orbital swelling or pain, swelling of the forehead, and/or diplopia should be urgently scheduled for evaluation.

    • Children with acute

Summary Statements

  • Summary Statement 1: It has been suggested that the term sinusitis be replaced by rhinosinusitis. NR

  • Summary Statement 2: Sinusitis is defined as inflammation of one or more of the paranasal sinuses. The most common cause of sinusitis is infection. Classification of sinusitis is frequently based on duration of symptoms, the specific sinus involved, or both. NR

  • Summary Statement 3: The most commonly used classification is as follows (NR):

    • a.

      Acute sinusitis: symptoms for less than 4 weeks consisting

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    Disclosure of potential conflict of interest: E. Wald has received grants from GlaxoSmithKline, MedImmune, and Sanofi Pasteur. F. Virant has received grants from Abbott, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Dey Labs, Genentech, GlaxoSmithKline, Hoffman LaRoche, Immunex, Key, Lederle, Lilly Research, Merck, Novartis, Pfizer, Purdue Fredrick, Sandofi, Schering, Sepracor, TAP Pharmaceuticals, 3M Pharmaceuticals, UCN Pharma, Upjohn Laboratories, and Med Point Pharmaceuticals; has consultant arrangements with NeoRex; and is on the speakers' bureau for GlaxoSmithKline, Aventis, Merck, Pfizer, Schering, AstraZeneca, and IDEC. S. Tilles has received grants from GlaxoSmithKline, Aventis, and Novartis and is on the speakers' bureau for GlaxoSmithKline, Aventis, and Pfizer. J. Oppenheim has consultant arrangements with Sepracor, GlaxoSmithKline, AstraZeneca, and Roche; has received grants from Boehringer Ingelheim, Schering, GlaxoSmithKline, Merck, Sepracor, AstraZeneca, Novartis and Altana; and is on the speakers' bureau for Sepracor, GlaxoSmithKline, AstraZeneca, Novartis, and Merck. D. Khan has consultant arrangements with Pfizer; has received grants from AstraZeneca; and is on the speakers' bureau for Merck, Pfizer, GlaxoSmithKline, and Aventis. D. Kennedy has consultant arrangements with Medtronic-Xomed and Schering-Plough; has received grants from Novartis; and is on the speakers' bureau for Merck. M. Kaliner has consultant arrangements with Aventis, Medpoint, Glaxo, Gasser, Adams, and King; has received grants from numerous pharmaceutical companies that are researching allergies; and is on the speakers' bureau for Aventis, Medpoint, GlaxoSmithKline, Gasser, and Abbot.

    Reprint requests: Joint Council of Allergy, Asthma and Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067.

    This parameter was edited by Dr Nicklas in his private capacity and not in his capacity as a medical officer with the Food and Drug Administration. No official support or endorsement by the Food and Drug Administration is intended or should be inferred.

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