4 VIEWS &: REVIEWS Acute sinusitis: guidelines for diagnosis and treabnent Five signs and symptoms are diagnostic of acute sinusitis, report investigators in Canada. They examined published research and discussed their findings with experts at the 1996 Canadian Sinusitis Symposium to derive guidelines for the diagnosis and treatment of acute sinusitis in other- wise healthy patients. Predictive signs and symptoms The 5 best clinical predictors of acute sinusitis are: • maxillary toothache • purulent secretion • poor response to decongestants • abnormal transillumination results • history of coloured nasal discharge. Acute sinusitis can be ruled out if < 2 of the predictors are present, say the investigators, while the presence of 4 or more indicates a 'very high' likelihood of acute sinusitis. Further diagnostic efforts are only warranted when the presence of 2 or 3 predictors makes a diagnosis unclear. In such cases, the investigators recommend sinus radiography to aid the diagnostic process. Noting that about 90% of cases of acute sinusitis involve the maxillary sinuses, the investigators recommend radiological diagnosis using only the Waters view; other views should only be used when this is inconclusive. They report that computerised tomography is not cost-effective. Recommended treatment The investigators report that antimicrobial therapy for acute bacterial sinusitis is beneficial, with 10-day amoxicillin therapy the first-line treatment. Decon- gestants may be helpful as adjunctive therapy, say the investigators, but antihistamines are contraindicated. They note that 'dramatic' pain relief and the pre- vention of irreversible mucosal damage may be obtained by irrigation and drainage of the nasal cavity with physiological saline solution. In cases involving complications, severe pain or poor response to treatment, the investigators note that functional endoscopic sinus surgery produces moderate to complete relief of symptoms in 80-90% of patients. Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, et aI. A practical guide for the diagnosis and treatment of acute sinusitis. Canadian Medical Association Journal 156 (Suppl.): SI ·SI4, 15 Mar 1997 Inphanns- 3 Mey 1997 No. 1085 1173-8324197/1085·00041$01.00° Adi. Internationa' Limited 1997. All right. rHfiVad

Acute sinusitis: guidelines for diagnosis and treatment

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Page 1: Acute sinusitis: guidelines for diagnosis and treatment

4 VIEWS &: REVIEWS

Acute sinusitis: guidelines for diagnosis and treabnent

Five signs and symptoms are diagnostic of acute sinusitis, report investigators in Canada. They examined published research and discussed their findings with experts at the 1996 Canadian Sinusitis Symposium to derive guidelines for the diagnosis and treatment of acute sinusitis in other-wise healthy patients.

Predictive signs and symptoms The 5 best clinical predictors of acute sinusitis are:

• maxillary toothache • purulent secretion • poor response to decongestants • abnormal transillumination results • history of coloured nasal discharge.

Acute sinusitis can be ruled out if < 2 of the predictors are present, say the investigators, while the presence of 4 or more indicates a 'very high' likelihood of acute sinusitis. Further diagnostic efforts are only warranted when the presence of 2 or 3 predictors makes a diagnosis unclear. In such cases, the investigators recommend sinus radiography to aid the diagnostic process.

Noting that about 90% of cases of acute sinusitis involve the maxillary sinuses, the investigators recommend radiological diagnosis using only the Waters view; other views should only be used when this is inconclusive. They report that computerised tomography is not cost-effective.

Recommended treatment The investigators report that antimicrobial therapy

for acute bacterial sinusitis is beneficial, with 10-day amoxicillin therapy the first-line treatment. Decon-gestants may be helpful as adjunctive therapy, say the investigators, but antihistamines are contraindicated. They note that 'dramatic' pain relief and the pre-vention of irreversible mucosal damage may be obtained by irrigation and drainage of the nasal cavity with physiological saline solution.

In cases involving complications, severe pain or poor response to treatment, the investigators note that functional endoscopic sinus surgery produces moderate to complete relief of symptoms in 80-90% of patients. Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, et aI. A practical guide for the diagnosis and treatment of acute sinusitis. Canadian Medical Association Journal 156 (Suppl.): SI ·SI4, 15 Mar 1997

Inphanns- 3 Mey 1997 No. 1085 1173-8324197/1085·00041$01.00° Adi. Internationa' Limited 1997. All right. rHfiVad