RHINOSINUSITIS : Current Concepts in Evaluation and Management - 07/09/11

Doi : 10.1016/S0025-7125(05)70085-7

J. David Osguthorpe, MD ^a, James A. Hadley, MD, FACS ^b

^a Department of Otolaryngology and Communicative Science, Medical University of South Carolina (JDO), Charleston, South Carolina

^b Department of Otolaryngology, University of Rochester Medical Center (JAH), Rochester, New York

Resumen

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 Hahn D, Lefkowitz D: Annual expenses and sources of payment for health care services. Washington, DC, National Expenditure Survey Research Findings 14, Agency for Health Care Policy and Research, Publication 93-0007, 1994

Haga clic aquí para ir a la sección de Referencias} 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 Hahn D, Lefkowitz D: Annual expenses and sources of payment for health care services. Washington, DC, National Expenditure Survey Research Findings 14, Agency for Health Care Policy and Research, Publication 93-0007, 1994

Haga clic aquí para ir a la sección de Referencias, 15 Kaliner M., Osguthorpe J., Fireman P. , y al. Sinusitis: Bench to Bedside Otolaryngol Head Neck Surg 1997 ; 116 (suppl) :

Haga clic aquí para ir a la sección de Referencias} 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 Benson V., Marano M. Current estimates from the 1993 National Health Interview Survey. National Center for Health Statistics Vital Health Stat 1994 ; 10 : 190

Haga clic aquí para ir a la sección de Referencias} 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 Anon J (guest ed): Report of the Rhinosinusitis Task Force Committee Meeting. Otolaryngol Head Neck Surg 117(suppl), 1997.

Haga clic aquí para ir a la sección de Referencias, 10 Gliklich R., Metsen R. The health impact of chronic sinusitis in patients seeking otolaryngologic care Otolaryngol Head Neck Surg 1995 ; 113 : 104-109 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 15 Kaliner M., Osguthorpe J., Fireman P. , y al. Sinusitis: Bench to Bedside Otolaryngol Head Neck Surg 1997 ; 116 (suppl) :

Haga clic aquí para ir a la sección de Referencias}

In 1996, the American Academy of Otolaryngology–Head and Neck Surgery standardized the terminology for paranasal infections.^{2 Anon J (guest ed): Report of the Rhinosinusitis Task Force Committee Meeting. Otolaryngol Head Neck Surg 117(suppl), 1997.

Haga clic aquí para ir a la sección de Referencias} 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 Hadley J., Schaefer S. Clinical evaluation of rhinosinusitis Otolaryngol Head Neck Surg 1997 ; 117 : S8-S11

Haga clic aquí para ir a la sección de Referencias, 16 Lanza D., Kennedy D. Adult rhinosinusitis defined Otolaryngol Head Neck Surg 1997 ; 117 : S1-S7

Haga clic aquí para ir a la sección de Referencias} 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.