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The American Academy of Otolaryngology—Head and Neck Surgery Foundation has p ublished an updated “Clinical Practice Guideline: Adult Sinusitis” as a supplement to Otolaryngology–Head and Neck Surgery. The guideline recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. The treatment recommendations include: Symptoms of viral sinusitis can be treated symptomatically by relieving pain, and administration of nasal steroid sprays, and/or nasal saline rinse (irrigation). Acute bacterial sinus can be watchful waited without antibiotics ...

A recent study in JAMA Otolaryngology--Head& Neck Surgery , in October 2013, suggested that chronic rhinosinusitis (CRS) may be caused by an overactive immune response to normal microbes, and not necessarily to bacterial infection. Investigators from Saint Louis University School of  Medicine in Missouri lead by Dr. Rajeev Aurora found that patients and healthy controls tended to have qualitatively similar microorganisms in their sinus cavity. While control patients sinus lavage samples triggered interleukin (IL)-5 production in peripheral blood leukocytes from patients, this did not occur with leukocytes from controls. The investigators obtained sinus cavity samples from thirty patients with CRS and 12 controls. They used deep sequencing to characterize the patients'  microbiomes and search for pathogens that may potentially trigger an immune response. They also identified the immune cells and cytokines in the specimens. Almost all the recovered fungal and bacterial speci...

Acute invasive fungal sinusitis (AIFS) is an aggressive and often fatal infection. Despite improvements in medical and surgical therapy, survival remains limited and the factors that contribute to patient outcomes remain poorly understood. Turner et al from the Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee performeda  systematically reviews of  the literature to characterize prognostic factors associated with survival after AIFS.. The authors reviewed 52 studies comprising a total of 807 patients, and analyzed the prognostic factors as they related to the treatment, presentation, and outcomes. Univariate and multivariate logistic regression was used to identify prognostic factors. The most common presenting symptoms of patients with AIFS were facial swelling (64.5%), fever (62.9%), and nasal congestion (52.2%). Most patients were treated with a combination of intravenous antifungal medication and surgery. Th...

The US Food and Drug Administration (FDA) has issued guidelines for the pharmaceutical  industry for developing antimicrobials for the treatment of acute bacterial sinusitis (ABS). The FDA stated that any new drug being studied for ABS should have documenting in-vitro antibacterial activity against the most commonly pathogens associated with ABS. These include  Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Even though animal models of ABS has been developed, particularly for S. pneumoniae infection, they cannot substitute for clinical trials in patients that must be conducted to evaluate drug safety and efficacy. The FDA recommend that two adequate and well-controlled human trials establishing safety and efficacy be conducted for that indication.  However, a single trial for an ABS indication may be appropriate if there is data from other clinical trials demonstrating effectiveness in other respiratory...

The new guideline emphasize that the vast majority of sinus infections are caused by viruses and should not be treated with antibiotics. In those cases the new guidelines call for shorter treatment time than older guidance, which suggested a 10 to 14 days weeks of antibiotic treatment for a bacterial infection. The IDSA  guideline  suggests that five to seven days is long enough to treat  most bacterial infection without encouraging resistance in adults, though children should still receive the longer course. Because of increasing resistance to amoxicillin (the current standard of care) the guideline recommends amoxicillin-clavulanate as the treatment of choice for acute sinusitis.   A moxicillin-clavulanate   is a combination that helps to overcome antimicrobial resistance by inhibiting an enzyme that breaks down the antibiotic. The guidelines also recommend against other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim/...

A recent   study by   Garbutt   and associates evaluated   the   effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute sinusitis. They performed   a randomized, placebo-controlled trial of 166 adults with uncomplicated, acute sinusitis between 2006 and 2009. Patients were randomized to receive a 10 days course of either amoxicillin ( 85 patients) or placebo (81 patients). All received a supply of symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed.   On day 3 of treatment, there was no difference in improvement between placebo-takers and those prescribed antibiotics. On day 7, the antibiotic group reported a slight improvement that the researchers said was unlikely to represent a noticeable relief in symptoms, but that edge disappeared by day 10, when 80 percent of patients in both groups reported they felt better or cured. The main problem in this study is that many of t...

Systemic corticosteroids are frequently used to treat acute sinusitis. A recent analysis of the Cochrane Central Register of Controlled Trials (CENTRAL) assess the effectiveness of systemic corticosteroids in relieving symptoms of acute   sinusitis . Four randomized controlled trials with a total of 1008 adult participants met the inclusion criteria. All participants received oral antibiotics and were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control   treatment   (placebo in three trials and non-steroidal anti-inflammatory drugs in one trial). In all trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control   treatment : at Days 3 to 7. An analysis of the three trials with placebo as a control   treatment   showed similar results but with a lesser effect size: No data on the long-term e...