Conclusion
The criteria available to accurately diagnose sinusitis has been reasonably established. However, no single test should be considered conclusive unless the clinical history fits the diagnosis of sinusitis. As with all other disciplines of medicine, there remains an \ldart\rd to the timing and choice of the appropriate test and formulating an interpretation before a final diagnosis can be secured. If the criteria set forth in this article are followed, we believe that considerable benefit will follow in terms of cost savings from limiting the number of inaccuracies in diagnosis and, therefore, needless and sometimes harmful treatment schemes. The haphazard manner in which potent, broad-spectrum antibiotic preparations are prescribed in some medical communities is likely the reason for the observed emergence of more and more resistant organisms in the ambulatory care setting.
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References
Moss AJ, Parsons VL. Current estimates from the National Health Interview Survey, Unites States—1985. Hyattsville, MD: National Center for Health Statistics, 1986:66,67; DHHS publication no. (PHS) 86–1588 (Vital and Health Statistics; series 10; no. 160).
National Disease and Therapeutic index. Plymouth Meeting, PA: IMS, 1988–1989; pp. 487,488.
Wald ER. Epidemiology, pathophysiology and etiology of sinusitis. Pediatr Infect Dis 1985;4:551–554.
Wald ER, Chiponis D, Ledesma-Medina J. Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics 1986;77:795–800.
Sykes DA, Wilson R, Chan KL, Mackay IS, Cole PJ. Relative importance of antibiotic and improved clearance in topical treatment of chronic mucopurulent rhinosinusitis. A controlled study. Lancet 1986;2:359,360.
Wald ER. Acute sinusitis in children. Adv Otolaryngol Head Neck Surg 1988;2:165–188.
Wald ER, Guerra N, Byrs C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics 1991;87:129–133.
van Cauwenberge P. Prevalence and etiology in pediatric sinusitis (abstract). XV Congress of European Rhinological Society and XIII International Symposium on Infection and Allergy of the Nose 1994;254.
Dretner B. Pathophysiology of paranasal sinuses with clinical implications. Clin Otolaryngol 1980;5:277–284.
Aust R, Drettner B. Elimination of contrast medium from the maxillary sinus. Acta Otolaryngol 1975;81:468–475.
Holstrom M, Lund VJ, Scadding G. Nasal ciliary beat frequency after nasal allergen challenge. Am J Rhinol 1992;6:101–105.
Carrenfelt C, Lundberg C. Purulent and non-purulent maxillary sinus secretions with respect to PO2, PCO2, and ph. Acta Otolaryngol 1977;84:138–144.
Kennedy DW. First-line management of sinusitis: a national problem? Otolaryngol Head Neck Surg 1990;103,5 part 2:849.
Wald ER, Reilly JS, Casselbrant M, et al. Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor. J Pediatr 1983; 104:297–302.
Evans FO, Sydnor B, Moore WEC, et al. Sinusitis of the maxillary antrum. N Engl J Med 1975;293:735–739.
Gwaltney JM. Microbiology of sinusitis. In: Sinusitis—Pathophysiology and Treatment, Druce HM, ed. Clinical Allergy and Immunology of series, New York: Marcel Dekker, 1993; p. 46.
Turner BW, Cail WS, Hendley JO, Hayden FG, Doyle WJ, et al. Physiologic abnormalities in the paranasal sinuses during experimental rhinovirus colds. J Allergy Clin Immunol 1992;90:474–478.
Hamory BH, Sande MA, Syndor A Jr, et al. Etiology and antimicrobial therapy of acute maxillary sinusitis. J Infect Dis 1979;139:197–202.
Wald ER, et al. J Pediatrics 1984;104:297–302.
Shapiro GG, Rachelefsky GS. Introduction and definition. Immunol 1992;90: 417,418.
Wald ER, Milmoe GJ, Bower A, et al. Acute maxillary sinusitis in children. N Engl J Med 1981;304:748–754.
Kogutt MS, Swischuk LE. Diagnosis of sinusitis in infants and children. Pediatrics 1973;52:121–124.
Rachelefsky GS, Goldberg M, Katz RM. Sinusitis disease in children with respiratory allergy. J Allergy Clin Immunol 1978;61:310–314.
Horshaw TC, Nickman NJ. Sinusitis and otitis in children. Arch Otolaryngol 1974;100:194,195.
Slavin RG. Sinusitis in adults and its relation to allergic rhinitis, asthma and nasal polyps. J Allergy Clin Immunol 1988;82:950–956.
Irvin CG. Sinusitis and asthma: an animal model. J Allergy Clin Immunol 1992;90:521–533.
Wilson NW, Jalowayski AA, Hamburger RN. A comparison of nasal cytology with sinus X-rays for the diagnosis of sinusitis. Am J Rhinol 1988;2:55–59.
Gill FF, Neiburger JB. The role of nasal cytology in the diagnosis of chronic sinusitis. Am J Rhinol 1989;3:13–15.
Meltzer EO, Jalowayski AA. Nasal cytology in clinical practice. Am J Rhinol 1988;2:47–54.
Evans FO, Syndor B, Moore WEC. Sinusitis of the maxillary antrum. J Laryngol Ontol 1963;77:1009–1013.
McNeill RA. Comparison of the findings on transillumination, X-ray and lavage of the maxillary sinus. J Laryngol Otol 1963;77:1009–1013.
Revonta M. Ultrasound in the diagnosis of macillary and frontal sinusitis. Acta Otolaryngol 1980;370(suppl):1–54.
Jannert M, Andreasson L, Holmer N-G, et al. Ultrasonic examination of the paranasal sinuses. Acta Otolaryngol 1982;389(suppl):1–51.
Berg O, Carenfelt C. Etiological diagnosis in sinusitis: ultrasonography as clinical component. Laryngoscope 1985;95:851–853.
Pfleidrer AG, Drake-Lee AB, Lowe D. Ultrasound of the sinuses: a worthwhile procedure? A comparison of ultrasound and radiography in predicting the findings of proof puncture on the maxillary sinuses. Clin Otolaryngol 1984;9:335–339.
Isaacson S, Edell SL. A-mode ultrasound evaluation of maxillary sinusitis. ORL 1978;86:231–235.
Landman MD. Ultrasound screening for sinus disease. Otolaryngol Head Neck Surg 1986;94:157–164.
Rohr AS, Spector SL, Siegel SC, et al. Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis. J Allergy Clin Immunol 1986;78:58–61.
Druce HM, Rutledge J. Chronic sinusitis and rhinitis. Am J Rhinol 1989;3:163–166.
Shapiro GG, Furukawa CT, Pierson WE, et al. Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol 1986;77:59–64.
Berger W, Weiss J. A comparison of A-mode ultrasound and X-ray for screening of maxillary sinus disease (abstract). J Allergy Clin Immunol 1985;75:187.
Incaudo GA. The diagnosis and treatment of rhinosinusitis during pregnancy and lactation. In: Schatz M and Zeiger RS, eds., Asthma and Allergy in Pregnancy and Early Infancy. New York: Marcel Dekker, 1993; pp. 287–306.
McAlister WH, Lusk R, Muntz HR. Comparison of plain radiographs and coronal cT scans in infants and children with recurrent sinusitis. Am J Roentgenol 1989;153:1259–1264.
Garcia DP, Corbett ML, Eberly SM, Joyce MR. Radiographic imaging studies in pediatric chronic sinusitis. J Allergy Clin Immunol 1994;94:523–530.
Andrew WK, Swart JG. Fallibility of sinus radiographs in demonstrating ethmoid sinusitis. S Afr Med J 1987;72:158.
Mann WJ, Amedee RG, Jemma M. An assessment of radiologic discrepancies in patients with paranasal sinus disease. Am J Rhinol 1992;6:211–213.
Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991;104:480–483.
Diament MJ, Senac JR, Gilsanz V, Baker S, Gillespie T, Larsson S. Prevalence of incidental paranasal sinus opacification in pediatric patients: a CT study. J Comp Asst Tomogr 1987;11:426–431.
Glasier CM, Archer DP, Williams KD. Incidental paranasal sinus abnormalities on CT of children: clinical correlation. Am J Neuroradiol 1986;7:861–864.
Glasier CM, Mallory GB, Steele RW. Significance of opacification of the maxillary and ethmoid sinuses in infants. J Pediatr 1989;114:45–50.
Kovatch AL, Wald ER, Ledesma-Medina J, Chiponis DM, Bedlingfield DM. Maxillary sinus radiographs in children with nonrespiratory complaints. Pediatrics 1984; 73:306–308.
Lesserson JA, Kieserman SP, Finn DG. The radiographic incidence of chronic sinus disease in the pediatric population. Laryngoscope 1994;104:159–166.
Van der Veken PJV, Clement PAR, Buisseret T, et al. CT scan study of the incidence of sinus involvement and nasal anatomic variations in 196 children. Rhinology 1990;28:177–184.
Lazar RH, Younis RT, Parvey LS. Comparison of plain radiographs, coronal CT, and intraoperative findings in children with chronic sinusitis. Otolaryngol Head Neck Surg 1992;107:29–34.
Rak KM, Newell JD, Yakes WF, Damiano MA, Luethke JM. Paranasal sinuses on MR images of the brain: significance of mucosal thickening. Am J Roentgenol 1991;156:381–384.
Cook LD, Hadley DM. MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms. J Laryngol Otol 1991;105:278–281.
Havas TE, Motbey JA, Gullane PJ. Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1988;114:856–859.
Som PM, Lawson W, Biller HF, Lanzieri CF. Ethmoid sinus disease: CT evaluation in 400 cases. Part I. Nonsurgical patients. Radiology 1986;159:591–597.
Imbeau SA, Lucas JL, Meyer S. Nasal endoscopy: an advancement in diagnosis and treatment of sinusitis. J S Carolina Med Assoc 1991;87:257–261.
Vining EM, Yanagisawa K, Yanagisawa E. The importance of preoperative nasal endoscopy in patients with sinonasal disease. Laryngoscope 1993;103:512–519.
Gwaltney JM, Sydnor A, Sande MA, et al. Etiology and antimicrobial treatment of acute sinusitis. Ann Otol Rhinol Laryngol 1981;90(suppl 84):68.
Wald ER. Sinusitis. Pediatr Rev 1993;14:345–351.
Lew D, Southwick FS, Montgomery WW, Weber AL, Baker AS. Sphenoid sinusitis. N Engl J Med 1983;309:1149–1154.
Hahn DL, Dodge RW, Golubjaatnikov R. Association ofChlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis and adult-onset asthma. JAMA 1991;266:225–230.
Caplan ES and Hoyt NJ. Nosocomial sinusitis. JAMA 1982;247:639–641.
Linden BE, Aguilar EA, Allen SJ. Sinusitis in the nasotracheally intubated patient. Arch Otolaryngol Head Neck Surg 1988;114:860,861.
Schlanger G, Lutwick LI, Kurzman M, et al. Sinusitis caused byLegionella pneumophilia in a patient with the acquired immunodeficiency syndrome. Am J Med 1984;77:952.
Gonzalez MM, Gould E, Dickinson G, et al. Acquired immunodeficiency syndrome associated with acanthamoeba infection and other opportunistic organisms. Arch Pathol Lab Med 1986;110:749.
Thornsberry C, Brown SD, Yee C, Bouchillon SK, Marler JK, Rich T. Increasing penicillin resistance in streptococcus pneumoniae in the US. Infec Med (suppl):15–24.
Axelsson A, Brorson JE. The concentration of antibiotics in sinus secretions. Ann Otolaryngol 1974;83:323–330.
Scheld WM, Sydnor A, Farr B, Gratz JC, Gwaltney JM. Comparison of cyclacillin and amoxicillin for therapy of acute maxillary sinusitis. Antimicrob Agents Chemother 1986;30:350–353.
Iwasawa T. Fundamental and clinical studies with BRL25000 (Clavulanic acid-amoxicillin) in the otorhinologic field. Chemotherapy (Tokyo) 1982;30:612–625.
Wald ER, et al. Postgrad Med 1984;September–October:133–136.
Camacho AE, et al. Am J Med 1992;93:271–276.
Staniforth DH, Lillystone RJ, Jackson D. Effect of food on the bioavailability and tolerance of clavulanic acid/amoxycillin combination. J Antimicrob Chemother 1982;10,131–139.
Kohonen A, Paavolainen M, Renkonen OV. Concentration of cephalexin in maxillary sinus mucosa and secretion. Ann Clin Res 1975;7:50–53.
Schaefer SD and Ronis ML. Cephalexin in the treatment of acute and chronic maxillary sinusitis. Southern Med J 1985;78:45–48.
Kaminszczik, I. Treatment of acute and chronic sinusitis with cefadroxil. Drugs 1986;32(Suppl. 3):33–38.
Faden H, Doern G, Wolf J, Blocker M. Antimicrobial susceptibility of nasopharyngeal isolates of potential pathogens recovered from infants before antibiotic therapy: implications for the management of otitis media. Pediatr Infect Dis J 1994;13:609–612.
Sudderick RM, Lund, VJ, et al. An evaluation of the penetration of cefuroxime axetil into human paranasal sinus tissue. Rhinology 1992;30:11–16.
Barriere M, et al. Pharmacology and pharmacokinetics of cefprozil. CID 1992; 14(suppl 2):S18-S187.
Stenquist M, Lindahl D, Drikkson T, et al. Penetration of loracarbef into maxillary sinus fluid and tonsillary tissue after single dose administration. Abstract of the 17th International Congress of Chemotherapy, 1991.
Sydnor A, Gwaltney JM, Cocchetto DM, Scheld M. Comparative evaluation of cefuroxime axetil and cefaclor for treatment of acute bacterial maxillary sinusitis. Arch Otolaryngol Head Neck Surg 1989;115:1430–1433.
Wald ER, Reilly JS, Casselbrant MC, Chiponis DM. Treatment of acute sinusitis in children: Augmentin vs cefaclor. Postgrad Med 1984;(Augmentin Sym suppl Sept–Oct):133–136.
Camacho AE, Cobo, R, Otte J, Spector SL, et al. Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with acute bacterial maxillary sinusitis. Am J Med 1992;93:271–276.
Wijngaart W, Verbrugh H, Theopold HM, Bauernfeing A, et al. A noncomparative study of cefprozil at two dose levels in the treatment of acute uncomplicated bacterial sinusitis. Clin Ther 1992;14:306–312.
Sydnor TA, Scheld WM, Gwaltney J, Nielsen, Huck W, Therasse DG. Loracarbef (LY163892) vs amoxicillin/clavulanate in bacterial maxillary sinusitis. Ear Nose Throat J 1992;71:225–232.
Sader HS, Jones RN, Washington JA, Murray PR, et al. In vitro activity of cefpodoxime compared with other oral cephalosporins tested against 5556 recent clinical isolates from five medical centers. Diagn Microbiol Infect Dis 1993;17: 143–150.
Stone JW, Linong G, Andrews JM, Wise R. Cefixime, in-vitro activity, pharmacokinetics and tissue penetration J Antimicrob Chemother 1989;23:221–228.
Del Beccarol MA. Cefpodoxime proxetil. Pediatr Ann 1993;22:187–196.
Howie VM, Owen MJ. Bacteriologic and clinical efficacy of cefixime compared with amoxicillin in acute otitis media. Pediatr Infect Dis J 1987;6:989–991.
Gehanno P, Depondt J, Barry B, Simonet M, Dewer H. Comparison of cefpodoxime proxetil with cefaclor in the treatment of sinusitis J Antimicrob Chemother 1990;26(suppl E):87–91.
Hardy DJ, Hensey DM, Beyer JM, Vojtko C, McDonald EJ, Fernander PB. Comparative in vitro activities of new 14-, 15- and 16-membered macrolides. Antimicrob Agents Chemother 1988;32:1710–1719.
Moellering RC. Introduction: revolutionary changes in the macrolide and azalide antibiotics. Am J Med 1991;91(suppl 3A):3A-1S–3A-4S
Axelsson A, Brorson JE. The concentration of antibiotics in sinus secretions; ampicillin, cephradine and erythromycinestolate. Ann Otolaryngol 1974;83:323–330.
Fraschini F, Scaglione F, Pintucci G, Maccarinelli G, Dugnani S, Demartini G. The diffusion of clarithromycin and roxithromycin into nasal mucosa, tonsil and lung in humans J Antimicrob Chemother 1991;27(suppl A):61–65.
Schentag JJ, Ballow CH. Tissue-directed pharmacokinetics. Am J Med 1991; 91(suppl 3A):3A-5S–3A-11S.
Karma P, Pukander J, Pentila M, Ylikoski J, et al. The comparative efficacy and safety of clarithromycin and amoxycillin in the treatment of outpatients with acute maxillary sinusitis J Antimicrob Chemother 1991;27(suppl A):83–90.
Dubois J, Saint-Pierre C, Devcich K. Clarithromycin in the treatment of acute maxillary sinusitis. Abstract presented Second International Conference on the Macrolides, Azalides and Streptogramins—Venice, Italy, January 1994.
Dubois J, Saint-Pierre C, Tremblay C. Efficacy of clarithromycin vs. amoxicillin/clavulanate in the treatment of acute maxillary sinusitis. ENT J 1993; 72:1–5.
Felstead SJ, Daniel R, European Azithromycin Study Group. Short-course treatment of sinusitis and other upper respiratory tract infections with azithromycin: a comparison with erythromycin and amoxycillin. J Int Med Res 1991;19:363–372.
Cooper B, Lawlor M. Pneumococcal bacteremia during ciprofloxacin therapy for pneumococcal pneumonia. Am J Med 1989;87:475.
Blumberg HM, Rimland D, Carroll DJ, Terry P, Wachsmith IK. Rapid development of ciprofloxacin resistance in methicillin-susceptible and-resistantStaphylococcus aureus. J Infect Dis 163;1991:1279–1285.
Shalit I, Berger SA, Gorea A, Frimerman H. Widespread quinoline resistance among methicillin-resistant S. aureus isolates in a general hospital. Antimicrob Agents Chemother 1989;33:593,594.
Dan M, Englander M, Gorea A, Harel M, Berger SA. Concentrations of ciprofloxacin in external ear granulation tissue and maxillary sinus mucosa. Rev Infect Dis 1989;2(suppl 5):S1080.
Sanbe B, Yoshihama H, Ueda R, Kobayashi K, Ito Y, Lkada J, Inafuku M. Experimental and clinical studies on DL-8280 in the field of otorhinolaryngology. Chemotherapy (Tokyo) 1984;32(suppl 1):1019–1029.
Futalo T, et al. Fundamental and clinical studies on NY-198 in the field of otorhinolaryngology. Chemotherapy 1988;36(suppl 2):1280–1288.
Klossek JM. The use of oral ciprofloxacin (CIP) for the treatment of chronic ENT infections. An overview of French data. Presented at the 15th European Rhinologic Congress Copenhagen, June 19–23, 1994.
Nelson CT, Mason EO, Kaplan SL. Activity of oral antibiotics in middle ear and sinus infections caused by penicillin-resistantStreptococcus pneumoniae: implications for treatment. Pediatr Infect Dis J 1994;13:585–589.
Hammory BH, Sande MA, Sydnor A, Seale DL, Gwaltney JM. Etiology and antimicrobial therapy of acute maxillary sinusitis. J Infec Dis 1979;139:197–202.
Rachelefsky GS, Katz RM, Siegel SC. Chronic sinusitis in children with respiratory allergy: the role of antimicrobials. J Allergy Clin Immunol 1982;69:382–387.
Howie VM, Ploussard JH. Efficacy of fixed combination antibiotics versus separate components in otitis media. Clin Pediatr 1975;11:205.
Lambert-Zechovsky N, Mariani-Kurkdjian P, Doit C, Bourgeois F, Bingen E. J Hosp Pract 1992;22:89–97.
Shapiro GG. Sinusitis in children. J Allergy Clin Immunol 1988;81,5:1025–1027.
Daley CL, Sande M. The runny nose. Infection of the paranasal sinuses. Infect Dis Clin N Am 1988;2:131–147.
Coonan KM, Kaplan EL. In vitro susceptibility of recent North American Group A streptococcal isolates to eleven oral antibiotics. Pediatr Infect Dis J 1994;13:630–635.
Lundberg C, Gullers K, Malmborg AS. Antibiotics in sinus secretions. Lancet 1968;2:107,108.
Scandinavian Study Group J Antimicrob Chemother 1993;31:949–961.
van den Wijngaart W, Verbrugh H, et al. A noncomparative study of cefprozil at two dose levels in the treatment of acute uncomplicated bacterial sinusitis. Clin Ther 1992;14:306–312.
Klossek JM. The use of oral ciprofloxacin (CIP) for the treatment of chromic ENT infections. An overview of French data. Presented at the 15th European Rhinological congress. Copenhagen, June 19–23, 1994.
George DL, Falk PS, Nunally K, et al. Nosocomial sinusitis in medical intensive care unit (MICU) patients: a prospective epidemiologic study (abstract 13). Presented at the Second Annual Meeting of the Society of Hospital Epidemiologists of America. Baltimore MD, 1992.
Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med 1993;21:1132–1338.
Deutschman CS, Wilton P, Sinow J, Dibbell D, Konstantinides FN, Cerra FB. Crit Care Med 1986;14:111–114.
O’Donnell JG, Sorbello AF, Condoluci DV, Barnish MJ. Sinusitis, due to Pseudomonas aeruginosa in patients with human immunodeficiency virus infection. Clin Infect Dis 1993;16:404–406.
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Incaudo, G.A., Wooding, L.G. Diagnosis and treatment of acute and subacute sinusitis in children and adults. Clinic Rev Allerg Immunol 16, 157–204 (1998). https://doi.org/10.1007/BF02739329
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DOI: https://doi.org/10.1007/BF02739329