MANAGEMENT OF RHINOSINUSITIS: AN EVIDENCE BASED APPROACH

FCAAIA Notes: So if it looks like a sinus infection, smells like a sinus infection, and eels like a sinus infection, it must be a sinus infection, right?  Well, not necessarily. Every summary of chronic nasal and sinus disease will tell you that and that the overuse and abuse of antibiotics is common (Diagnosis and management of rhinosinusitis: A practice parameter update. Ann Allergy Asthma Immunol 2014; 113:347–385).  If your symptoms do not clear with antibiotics, you have to start to wonder if there is something else going on.

Sometimes radiographic imaging studies are done to assess the anatomy.  Aggressive anti-allergic treatments and sometimes surgical intervention are necessary. New treatments are constantly under development.  Unfortunately, when they are approved many are prohibitively expensive.

(Source: http://www.medscape.com/viewarticle/865732?src=wnl_tp10j_161215_mscpedit&uac=112079PK&impID=1254681&faf=1 Dec. 15, 2016. For Medscape articles: User name: FCAAIA, Password: Allergies)

Abstract

Purpose of review The most recent recommendations for the management of both acute (ARS) and chronic rhinosinusitis (CRS) based on the strongest data available for each treatment modality are summarized in this review. The clinical relationships between CRS and its comorbidities are also discussed.

Recent findings The most promising advances in rhinosinusitis management involve the use of mAbs (anti-IgE, anti-IL-5, anti-IL-4R[alpha]) in trials of CRS with nasal polyposis. Otherwise, the mainstays of treatment for both ARS and CRS have largely remained the same over the past several years.

Summary The treatment of ARS primarily involves symptomatic control with intranasal corticosteroids and nasal saline irrigation; antibiotics should be reserved for the patients who are believed to have bacterial rhinosinusitis. Treating CRS effectively involves using intranasal corticosteroids and irrigation, systemic corticosteroids, and potentially systemic antibiotics. Biologics (mAbs) have shown benefit in clinical studies. Providers should also be aware of concomitant disease processes that may afflict patients with CRS.

Introduction

Rhinosinusitis is characterized by symptomatic inflammation of the nasal cavity and paranasal sinuses that both decreases quality of life and poses a large economic cost on affected patients and society. The burden of rhinosinusitis from a population perspective is extensive; approximately 11% of US adults have received a diagnosis of sinusitis in their lifetime.[1] Recent estimates suggest that chronic rhinosinusitis (CRS) alone cost over $60 billion in 2011, and patients with acute rhinosinusitis (ARS) often seek medical attention despite the likelihood that the vast majority of cases will resolve without intervention.[2]

Unfortunately, the misprescription of therapy – especially antimicrobials – continues to plague most healthcare encounters for rhinosinusitis. A recent analysis of ambulatory care data from 2006 to 2010 in the United States nationally showed that 85.5% of office visits for ARS and 69.3% for CRS resulted in antibiotic prescriptions despite historical estimates that no more than 0.5–2% of cases of ARS involve a bacterial cause.[3,4] The following review highlights the indications for antibiotic prescription and clarifies which, and to what extent, management strategies for ARS and CRS are corroborated by objective evidence in the literature. Particular attention is paid to new data that have been published in the past year

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