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Chapter 8: Rhinosinusitis

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Abstract:

Rhinosinusitis is defined as inflammation of one or more of the paranasal sinuses and affects ∼16% of the population. Acute rhinosinusitis is defined as symptoms lasting <4 weeks and subacute rhinosinusitis is between 4 and 8 weeks. Chronic rhinosinusitis (CRS) is defined as symptoms lasting >8‐12 weeks. CRS is divided into three groups: CRS with nasal polyps, CRS without nasal polyps, and allergic fungal rhinosinusitis. The sinus cavities are lined with pseudostratified ciliated columnar epithelial cells interspersed with mucous goblet cells. Cilia continuously sweep the mucous toward the ostial openings and are important in maintaining the proper environment of the sinus cavities. The frontal, maxillary, and anterior ethmoid sinuses drain into the ostiomeatal unit of the middle meatus. The posterior ethmoid sinuses and superior sphenoid sinuses drain into the sphenoethmoid recess of the superior meatus. Most acute sinus infections are caused by viruses and, therefore, it is not surprising that the majority of patients improve within in 2 weeks without antibiotic treatment. A bacterial infection should be considered if symptoms worsen or fail to improve within 7‐10 days. Amoxicillin, trimethoprim-sulfamethoxazole, or doxycycline are first-line therapy. The Joint Task Force on Practice Parameters for Allergy and Immunology suggests assessing response to symptoms after 3‐5 days of therapy and continuing for an additional 7 days if there is improvement. Combining an intranasal corticosteroid with an antibiotic reduces symptoms more effectively than antibiotics alone.

Keywords: Acute rhinosinusitis; allergic fungal rhinosinusitis; antibiotic; bacterial infection; chronic rhinosinusitis; intranasal corticosteroid; nasal polyps; ostiomeatal unit; subacute rhinosinusitis

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2012.33.3538

Publication date: May 1, 2012

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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