Wed, 1 April 2015
This podcast highlights the updated clinical practice guideline on adult sinusitis that is published as an April 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the first of two podcasts for this supplement, Editor in chief John Krouse is joined by lead author Richard Rosenfeld and co-author Richard Orlandi in discussing key findings from the guideline in the diagnosis and treatment of adults with symptoms of sinusitis.
Sinusitis affects about 1 in 8 adults in the United States, resulting in more than 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life. More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth-most common diagnosis responsible for antibiotic therapy. Rhinosinusitis may be classified by duration as acute rhinosinusitis (ARS) if less than 4 weeks’ duration or as chronic rhinosinusitis (CRS) if lasting more than 12 weeks, with or without acute exacerbations. ARS may be classified further by presumed etiology, based on symptoms and time course, into acute bacterial rhinosinusitis (ABRS) or viral rhinosinusitis (VRS). Symptoms include purulent nasal discharge accompanied by nasal obstruction, facial pain/pressure/fullness, or both. Acute bacterial rhinosinusitis can be differentiated from acute viral rhinosinusitis if symptoms persist for at least 10 days without improvement or if symptoms worsen within 10 days after initial improvement. In addition, clinicians should not obtain radiographic imaging for uncomplicated acute rhinosinusitis. Furthermore, clinicians can consider watchful waiting without antibiotic treatment for uncomplicated acute sinusitis. Primary antibiotic therapy should include 5 to 10 days of amoxicillin with or without clavulate for most adults with sinusitis. These guidelines discuss additional recommendations and options for clinicians treating these adult patients with sinusitis.