Journal of Allergy and Clinical Immunology
The diagnosis and management of sinusitis: A practice parameter update
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
- a.
References (288)
- et al.
The health impact of chronic sinusitis in patients seeking otolaryngologic care
Otolaryngol Head Neck Surg
(1995) - et al.
Sinusitis: bench to bedside
J Allergy Clin Immunol
(1997) Chronic sinusitis in children
J Pediatr
(1995)Chronic sinusitis
J Allergy Clin Immunol
(2000)- et al.
The paranasal sinuses in CT-imaging: development from birth to age 25
Int J Pediatr Otorhinolaryngol
(1997) - et al.
Paranasal sinus computed tomography scan findings in patients with cystic fibrosis
Otolaryngol Head Neck Surg
(1996) - et al.
Bacteriology of the middle meatus in children
Pediatr Otorhinolaryngol
(1999) - et al.
The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis a fifteen year experience at the University of Virginia and review of other selected studies
J Allergy Clin Immunol
(1992) - et al.
Open label assessment of levofloxacin for the treatment of acute bacterial sinusitis in adults
Ann Allergy Asthma Immunol
(1998) - et al.
Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor
J Pediatr
(1984)
Subacute sinusitis in children
J Pediatr
Asthma and bacterial sinusitis in children
J Allergy Clin Immunol
The bacteriology of chronic maxillary sinusitis in children with respiratory allergy
J Allergy Clin Immunol
Treatment of chronic rhinosinusitis refractory to other treatments with topical antibiotic therapy delivered by means of a large-particle nebulizer: results of a controlled trial
Otolaryngol Head Neck Surg
Total and specific IgE in nasal polyps is related to local eosinophilic inflammation
J Allergy Clin Immunol
Evaluation and treatment of allergic fungal sinusitis. Demographics and diagnosis
J Allergy Clin Immunol
Fungal sinusitis
Am J Med Sci
Chronic rhinosinusitis: an enhanced immune response to ubiquitous airborne fungi
J Allergy Clin Immunol
Diagnosis of sinusitis in adults: history, physical examination, nasal cytology, echo, and rhinoscope
J Allergy Clin Immunol
Characteristics of patients with upper respiratory tract infection presenting to a walk-in clinic
Mayo Clin Proc
Diagnosis and treatment of upper respiratory tract infections in the primary care setting
Clin Ther
Diagnosis of sinusitis in children: emphasis on the history and physical examination
J Allergy Clin Immunol
Nonrhinologic headache in a tertiary rhinology practice
Otolaryngol Head Neck Surg
Comparison between transillumination and x-ray in diagnosing paranasal sinus disease
J Allergy Clin Immunol
Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings
Ann Allergy Asthma Immunol
Computed tomography imaging of the maxillary and ethmoid sinuses in children with short-duration purulent rhinorrhea
Otolaryngol Head Neck Surg
Paranasal sinus computed tomographic findings of children with chronic cough
Int J Pediatr Otolaryngol
Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis
J Allergy Clin Immunol
Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis
J Allergy Clin Immunol
Epidemiology and economic impact of rhinosinusitis
Ann Otol Rhinol Laryngol
Parameters for the diagnosis and management of sinusitis
J Allergy Clin Immunol
Adult rhinosinusitis defined
Otolaryngol Head Neck Surg
Rhinosinusitis: establishing definitions for clinical research and patient care
J Allergy Clin Immunol
Quantification for staging sinusitis. The Staging and Therapy Group
Ann Otol Rhinol Laryngol
A diagnostic dilemma for chronic rhinosinusitis: definition, accuracy and validity
Am J Rhinol
Development of the paranasal sinuses in children
Am J Rhinol
Pediatric sinonasal imaging: normal anatomy and inflammatory disease
Neuroimaging Clin N Am
Anatomy of the paranasal sinuses
Ostiomeatal complex risk factors for sinusitis: CT evaluation
J Otolaryngol
Functional endoscopic sinus surgery. Theory and diagnostic evaluation
Arch Otolaryngol
Basic experimental study of ostial patency and local metabolic environment of the maxillary sinus
Acta Otolaryngol Suppl
Oxygen tension in the human maxillary sinus during normal and pathological conditions
Acta Otolaryngol
Studies of gas exchange and pressure in the maxillary sinus in normal and infected humans
Rhinology
Acute community-acquired sinusitis
Clin Infect Dis
Role of middle meatus aspiration culture in the diagnosis of chronic sinusitis
Laryngoscope
Microbiology of the middle meatus: a comparison between normal adults and children
J Laryngol Otol
Acute maxillary sinusitis in children
N Engl J Med
Bacteriology of the maxillary sinuses in patients with cystic fibrosis
J Infect Dis
Efficacy of a stepwise protocol that includes intravenous antibiotic therapy for the management of chronic sinusitis in children and adolescents
Arch Otolaryngol Head Neck Surg
Antibiotic-resistant bacteria in pediatric chronic sinusitis
Pediatr Infect Dis J
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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.
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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.