RHINOSINUSITIS : Current Concepts in Evaluation and Management - 07/09/11
Résumé |
Sinusitis is one of the most common health complaints leading to a physician office visit in the United States. The National Hospital Discharge Survey documented 16,000 discharges for acute sinusitis and 29,000 for chronic sinusitis during 1993.13 It is also one of the leading causes for antibiotic prescriptions, and in 1992, there were approximately 73 million restricted activity days in patients with sinusitis and total direct medical costs of almost $2.4 billion (not including surgery or radiographic imaging), establishing sinusitis as one of the more costly disorders in the US population.13, 15 In the 1993 National Health Interview Survey, 14.7% of respondents reported having sinusitis the preceding year, with rates relatively higher in the Midwest and South and among women than men.4 Children less than 15 years of age and adults between 25 and 64 years of age are most frequently affected. In addition to the discomfort from the underlying disease, the cost of medications, and the lack of productivity during acute symptoms, those who develop chronic sinus disease experience health-related quality-of-life decrements in the domains of general health perception, vitality, and social functioning comparable to serious diseases, such as chronic obstructive pulmonary disease and angina pectoris.2, 10, 15
In 1996, the American Academy of Otolaryngology–Head and Neck Surgery standardized the terminology for paranasal infections.2 The term rhinosinusitis was deemed more appropriate than sinusitis because the mucous membranes of the nose and paranasal sinuses are embryologically and anatomically contiguous and respond similarly to medical and surgical therapy; purulent sinus disease without similar rhinitis is rare. Rhinosinusitis is divided among four classifications, based on the temporal course and the signs and symptoms of the disease (Table 1 and Table 2.12, 16 Succinctly, acute rhinosinusitis is of sudden onset and lasts less than 4 weeks, with complete resolution of symptoms; subacute rhinosinusitis is a continuum of acute rhinosinusitis beyond 4 weeks but less than 12 weeks; recurrent acute rhinosinusitis denotes four or more episodes of acute rhinosinusitis, lasting at least 7 days each, in any 1-year period; and chronic rhinosinusitis means signs or symptoms persist 12 weeks or longer. Chronic rhinosinusitis may be punctuated by acute infectious episodes. Salient aspects in diagnosing the signs and symptoms associated with rhinosinusitis have been grouped into major factors (facial pain or pressure, facial congestion or fullness, nasal obstruction, nasal or postnasal purulence, hyposmia, fever) and minor factors (headache, halitosis, fatigue, dental pain, cough, otalgia), which achieve diagnostic significance only in tandem with one or more major factors.
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Vol 83 - N° 1
P. 27-41 - janvier 1999 Retour au numéro
Article précédent
- EVALUATION AND MANAGEMENT OF ALLERGIC RHINITIS
- James A. Hadley
- EPISTAXIS
- Luke K.S. Tan, Karen H. Calhoun
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