Allergic rhinitis and upper respiratory tract infections. Cleveland Press: Case Western Reserve University, 1964:347. Illness in the home: a study of 25,000 illnesses in a group of Cleveland families. Trends in antimicrobial drug prescribing among office-based physicians in the United States. Current estimates from the National Health Interview Survey, 1992. 33 Acute sinusitis is caused by the same organisms that cause otitis media, and drug choices are similar.īenson V, Marano MA. In a study of children two to 16 years of age with acute maxillary sinusitis, the overall cure rate on day 10 was 67 percent for amoxicillin, 64 percent for amoxicillin-clavulanate potassium (Augmentin) and 43 percent for placebo. The median duration of sinusitis in the amoxicillin, penicillin and placebo groups was nine, 11 and 17 days, respectively. Eighty-six percent of the antibiotic group considered themselves cured or much better, compared with 57 percent of the placebo group. A study 34 in a Norwegian general practice compared amoxicillin, penicillin and placebo in the treatment of adult patients with acute sinusitis. In contrast, other randomized controlled trials 33, 34 have demonstrated the effectiveness of antibiotic treatment of acute sinus infections in adults and children. After two weeks, 83 percent of the amoxicillin group and 77 percent of the placebo group had greatly reduced symptoms, and 65 percent and 53 percent, respectively, were cured. A recent study 32 of adult patients with acute maxillary sinusitis diagnosed by using clinical and radiographic examinations and treated with amoxicillin (in a dosage of 250 mg three times daily for seven days) or placebo showed no significant difference in outcomes. The appropriate role of antibiotics in the treatment of acute sinusitis is not clear. The osteo-meatal complex is important because the frontal, ethmoid and maxillary sinuses drain through this area. The posterior ethmoid and sphenoid sinuses open into the superior meatus and sphenoethmoid recess. The ostia of the frontal, maxillary and anterior ethmoid sinuses open into the osteomeatal complex, which lies in the middle meatus lateral to the middle turbinate. The sinuses are lined with mucoperiosteum, which is thinner and less richly supplied with blood vessels and glands than the mucosa of the nasal cavity. They remain connected to the nasal cavity via narrow ostia with a lumen diameter of 1 to 3 mm ( Figure 1). The four paranasal sinuses (maxillary, frontal, ethmoid and sphenoid) develop as outpouchings of the nasal mucosa. The function of the paranasal sinuses is not clear, but theories include humidification and warming of inspired air, lightening of the skull, improvement of vocal resonance, absorption of shock to the face or skull, and secretion of mucus to assist with air filtration. Patients with recurrent or chronic sinusitis require referral to an otolaryngologist for consideration of functional endoscopic sinus surgery. Little evidence supports the use of adjunctive treatments such as nasal corticosteroids and systemic decongestants. First-line antibiotics such as amoxicillin or trimethoprimsulfamethoxazole are as effective in the treatment of sinusitis as the more expensive antibiotics. Since sinusitis is self-limited in 40 to 50 percent of patients, the expensive, newer-generation antibiotics should not be used as first-line therapy. Radiographs and computed tomographic scans of the sinuses generally are not useful in making the initial diagnosis. The diagnosis is based on the patient's history of a biphasic illness (“double sickening”), purulent rhinorrhea, maxillary toothache, pain on leaning forward, pain with a unilateral prominence and a poor response to decongestant therapy. Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions.
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