Sinusitis - Rhinosinusitis
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Sinusitis - Rhinosinusitis
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
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General Information
When surgery, antibiotics, and steroids fail to resolve chronic rhinosinusitis. (Immunol Allergy Clin North Am. 2009)
Daily Nasal Saline Irrigation Not Recommended for Long-Term Use “Daily long-term use of nasal saline irrigation (NSI) by patients with recurrent rhinosinusitis (RS) can increase the frequency of acute infection by as much as 60%, according to a new study presented here at the American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting. Many called the study "important." "We have a serious problem with many patients who suffer with chronic sinus disease thinking that the best treatment is daily [NSI]. They think it isn't harmful and so use it all the time," said lead investigator Talal M. Nsouli, MD, clinical professor of pediatrics and allergy/immunology at Georgetown University Hospital School of Medicine and medical director at the Watergate and Burke Allergy and Asthma Research Centers in Virginia. He presented the results during a podium session. Afterward, Dr. Nsouli told Medscape Allergy & Clinical Immunology that he has no problems with the use of NSI over a short term, and that previous studies have shown that it can improve nasal mucociliary clearance. However, "despite the common use of [NSI], or neti pots, in the treatment of sinus disease over a long period of time, there has been little evidence to confirm its success." For this study, the investigators hypothesized that the "long-term use of NSI may deplete the nose of its immune blanket of mucus, resulting in recurrent RS." “
Guidelines
Clinical Features May Not Identify Need for Treatment in Rhinosinusitis “Common clinical signs and symptoms may not identify patients with rhinosinusitis for whom treatment appears justified, according to the results of a meta-analysis of randomized trials reported in the March 15 issue of The Lancet. Therefore, antibiotics are not the best approach even if a patient reports symptoms for longer than 7 to 10 days, the study authors suggest. "Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult," write Jim Young, PhD, from the Basel Institute for Clinical Epidemiology, University Hospital Basel in Basel, Switzerland, and colleagues. "We undertook a meta-analysis of randomised trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics. … "Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified," the study authors write. "Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days. . . . In line with other meta-analyses, our analysis shows that 64% of patients were cured at 14 days even without antibiotic treatment." • The study authors warn that high fever, periorbital swelling, erythema, or intense facial pain suggests a serious complication requiring prompt treatment with antibiotics. … One third of upper respiratory tract infections in the United States are diagnosed as acute rhinosinusitis. The majority of patients in the United States and Europe with this diagnosis receive antibiotics. • The current meta-analysis suggests that although the presence of purulent nasal discharge may slightly increase the rate of cure associated with antibiotic treatment, antibiotics should not be routinely prescribed for uncomplicated acute rhinosinusitis. “
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Other
Other Treatments
Nasal Saline Irrigation and Neti Pots
Clear Your Congestion Naturally
Steroid Nasal Wash Appears To Improve Health Of Patients With Chronic Rhinosinusitis
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Surgery
An evidence-based review of endoscopic frontal sinus surgery. (NY.Am J Rhinol Allergy. 2009) “CONCLUSION: Despite the number of reports in the literature that address the surgical outcome of endoscopic approaches for treatment of frontal sinus disease, the majority of these studies have a small population size, short follow-up period, and provide a low clinical evidence level.”
Symptom outcomes following endoscopic sinus surgery. (Curr Opin Otolaryngol Head Neck Surg. 2009)
Transplantation
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