今日の臨床サポート

急性副鼻腔炎

著者: 鈴木賢二 医療法人尚徳会 ヨナハ総合病院

監修: 森山寛 東京慈恵会医科大学附属病院

著者校正/監修レビュー済:2021/06/30
参考ガイドライン:
  1. 日本感染症学会:気道感染症の抗菌薬適正使用に関する提言
  1. 日本鼻科学会:急性鼻副鼻腔炎診療ガイドライン2010年版 追補版
患者向け説明資料

概要・推奨   

  1. 全身ステロイドと抗菌薬の併用による治療は症状の期間を短くする可能性があり、治療のオプションとして考慮してもよい。
  1. 海外のIDSAのガイドラインでは治療の期間は5~10日程度を推奨している(推奨度2)。
  1. 急性細菌性副鼻腔炎に対して、抗菌薬による治療は症状の期間軽減に効果があり、推奨される(推奨度2)。
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  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となり
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
鈴木賢二 : 講演料(杏林製薬株式会社)[2021年]
監修:森山寛 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、気道感染症に対する推奨抗菌薬使用法について加筆修正を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 副鼻腔には上顎洞・篩骨洞・蝶形骨洞・前頭洞があり、それぞれ左右1対ずつ存在している。これらに生じた炎症を総称して副鼻腔炎と呼ぶ。
  1. 通常鼻炎も伴うため、近年は、「鼻副鼻腔炎」と呼ぶ考えが世界的に主流となっている。その病態から急性と慢性(含急性増悪症)に大別される[1]。急性細菌性鼻副鼻腔炎は「急性に発症し、罹病期間が1カ月以内と短く、鼻閉、鼻漏、後鼻漏、咳嗽を認め、頭痛、頬部痛、顔面圧迫感などを伴う疾患」と定義される[2]
  1. 最近では多量の膿性鼻汁を伴った重症の副鼻腔炎は減少傾向にあり、代わりにアレルギー性鼻副鼻腔炎が増加している[3]
 
  1. わが国における急性副鼻腔炎の起炎菌は肺炎球菌、インフルエンザ菌、モラクセラカタラーリス菌が多く、3菌種で53%ほどを占めている。嫌気性菌も14%足らず検出される。
  1. 近年薬剤耐性菌が増加して、肺炎球菌は34%、インフルエンザ菌は62%ほど、モラクセラカタラーリス菌は85%に上っている[4]
問診・診察のポイント  
問診:
  1. 以下の項目を問診する。

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文献 

著者: Stephanie S Smith, Elisabeth H Ference, Charlesnika T Evans, Bruce K Tan, Robert C Kern, Rakesh K Chandra
雑誌名: Laryngoscope. 2015 Jan;125(1):57-69. doi: 10.1002/lary.24709. Epub 2014 Sep 17.
Abstract/Text OBJECTIVES/HYPOTHESIS: To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS).
METHODS: Electronic databases were systematically searched for relevant studies published up to June 2012.
RESULTS: Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%).
CONCLUSIONS: Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.

© 2014 The American Laryngological, Rhinological and Otological Society, Inc.
PMID 24723427  Laryngoscope. 2015 Jan;125(1):57-69. doi: 10.1002/lary.・・・
著者: Gilead Berger, David M Steinberg, Aron Popovtzer, Dov Ophir
雑誌名: Eur Arch Otorhinolaryngol. 2005 May;262(5):416-22. doi: 10.1007/s00405-004-0830-0. Epub 2004 Sep 18.
Abstract/Text The aim of the study was to estimate the sensitivity and specificity of endoscopy and the diagnostic value of clinical criteria for acute bacterial rhinosinusitis (ABRS). The hospital records of 117 consecutive patients who had symptoms compatible with ABRS and who underwent sinus radiography and flexible nasendoscopy were retrieved. A positive diagnosis was entertained when radiography demonstrated air fluid level, complete opacification or at least 6 mm mucosal thickening and/or endoscopy revealed purulent material within the drainage area of the sinuses. Using a modified version of the Hui and Walter procedure, the sensitivity and specificity of nasendoscopy was calculated against sinus radiography, a standard reference test, with known estimated sensitivity (76%) and specificity (79%). The findings show that 40 patients (34%) had positive endoscopy and radiography. Twenty patients (17%) had positive endoscopy and negative radiography, and vice versa in 15 (13%). In 42 patients (36%) both modalities were negative. Endoscopy yielded a sensitivity of 80% (95% CI, 0.55-1.00) and a specificity of 94% (95% CI, 0.33-1.00). Although estimates seem better than those of radiography, the confidence intervals are quite wide and no firm conclusion is drawn. Neither single nor combination of symptoms, concurrent with two major and one minor factor advocated by the AAO-HNS Task Force on Rhinosinusitis, were associated with a positive diagnosis of ABRS. The data suggest that endoscopy is no less effective than radiography in predicting ABRS, also that clinical criteria are of rather limited diagnostic value, and thus should be supported by other diagnostic tests. Endoscopy is recommended as a first line diagnostic tool for the diagnosis of ABRS in routine ENT practice. If the outcome is negative, radiography may follow.

PMID 15378314  Eur Arch Otorhinolaryngol. 2005 May;262(5):416-22. doi:・・・
著者: T M Aaløkken, T Hagtvedt, I Dalen, A Kolbenstvedt
雑誌名: Dentomaxillofac Radiol. 2003 Jan;32(1):60-2. doi: 10.1259/dmfr/65139094.
Abstract/Text OBJECTIVES: To evaluate the value of plain film radiography in a prospective investigation of patients with clinical suspicion of acute sinusitis, using standard CT as a gold standard.
METHODS: 47 consecutive patients were examined. Each patient underwent conventional X-ray and standard dose CT examinations on the same day. The sensitivity and specificity of the plain film examination were calculated.
RESULTS: The specificity of the plain film examination was high, but the sensitivity was low except for the maxillary sinus (sensitivity 80%). Thus, for maxillary sinusitis, plain film examination was reasonably accurate. A negative finding in the other sinuses could not be relied upon.
CONCLUSIONS: The sensitivity of plain film radiography for detecting sinus opacifications was unacceptably low for the ethmoid, frontal and sphenoid sinuses. The specificity was high.

PMID 12820855  Dentomaxillofac Radiol. 2003 Jan;32(1):60-2. doi: 10.12・・・
著者: Janet R Reid
雑誌名: Pediatr Radiol. 2004 Dec;34(12):933-42. doi: 10.1007/s00247-004-1252-2. Epub 2004 Jul 27.
Abstract/Text Acute paranasal sinus infection in children is often diagnosed clinically without the need for radiographic confirmation. Most cases have a favorable outcome following appropriate antibiotic therapy. A small percentage of cases where symptoms and signs are persistent or severe will require emergent imaging to rule out complications related to local spread of disease intraorbitally or intracranially. A strong index of suspicion is required in such cases, and cross-sectional imaging evaluation with CT and MRI should include axial and coronal images of the paranasal sinuses and, where appropriate, the orbits and brain (with attention to the cavernous sinus). There is no role for plain radiography in the evaluation of the complications of acute sinusitis in the pediatric patient.

PMID 15278322  Pediatr Radiol. 2004 Dec;34(12):933-42. doi: 10.1007/s0・・・
著者: Iizhak Brook
雑誌名: Ann Otol Rhinol Laryngol. 2002 Nov;111(11):1002-4.
Abstract/Text Aspirates of 16 acutely infected and 7 chronically infected sphenoid sinuses were processed for aerobic and anaerobic bacteria. A total of 29 isolates were recovered from the 16 cases of acute sphenoid sinusitis (1.8 per specimen): 22 aerobic and facultative (1.4 per specimen), and 7 anaerobic (0.4 per specimen). Aerobic and facultative organisms alone were recovered in 10 specimens (62%), anaerobes alone were isolated in 3 (19%), and mixed aerobic and anaerobic bacteria were recovered in 3 (19%). The predominant aerobic and facultative species were Staphylococcus aureus (9 isolates), Streptococcus spp (9), and Haemophilus influenzae (2). A total of 28 isolates were recovered from the 7 cases of chronic sphenoid sinusitis (4.0 per specimen): 11 aerobic and facultative (1.6 per specimen) and 17 anaerobic (2.4 per specimen). Aerobic and facultative organisms alone were recovered in I instance (14%), anaerobes alone in 3 instances (43%), and mixed aerobes and anaerobes in 3 instances (43%). The predominant aerobic bacteria were gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa; 1 each). The predominant anaerobes included Peptostreptococcus spp (4 isolates), Prevotella spp (5), and Fusobacterium spp (4). These findings illustrate the unique microbiology of acute and chronic sphenoid sinusitis.

PMID 12450174  Ann Otol Rhinol Laryngol. 2002 Nov;111(11):1002-4.
著者: Itzhak Brook
雑誌名: J Clin Microbiol. 2005 Jul;43(7):3479-80. doi: 10.1128/JCM.43.7.3479-3480.2005.
Abstract/Text Aspirates from 26 acutely and 17 chronically infected ethmoid sinuses were studied. Thirty-seven aerobes and 10 anaerobes were recovered from isolates from patients with acute sinusitis. Streptococcus pneumoniae and Haemophilus influenzae were predominant. Twenty-seven aerobes and 41 anaerobes were found in isolates from patients with chronic sinusitis. The predominant isolates were anaerobic gram-negative bacilli and Peptostreptococcus spp.

PMID 16000483  J Clin Microbiol. 2005 Jul;43(7):3479-80. doi: 10.1128/・・・
著者: J M Gwaltney
雑誌名: Clin Infect Dis. 1996 Dec;23(6):1209-23; quiz 1224-5.
Abstract/Text
PMID 8953061  Clin Infect Dis. 1996 Dec;23(6):1209-23; quiz 1224-5.
著者: Jack B Anon, Michael R Jacobs, Michael D Poole, Paul G Ambrose, Mark S Benninger, James A Hadley, William A Craig, Sinus And Allergy Health Partnership
雑誌名: Otolaryngol Head Neck Surg. 2004 Jan;130(1 Suppl):1-45. doi: 10.1016/j.otohns.2003.12.003.
Abstract/Text
PMID 14726904  Otolaryngol Head Neck Surg. 2004 Jan;130(1 Suppl):1-45.・・・
著者: I Brook, E H Frazier, M E Gher
雑誌名: J Periodontol. 1996 Jun;67(6):608-10. doi: 10.1902/jop.1996.67.6.608.
Abstract/Text Aspirate of pus from 5 periapical abscesses of the upper jaw and their corresponding maxillary sinusitis were studied for aerobic and anaerobic bacteria. Polymicrobial flora were found in all instances, where the number of isolates varied from 2 to 5. Anaerobes were recovered from all specimens. The predominant isolates were Prevotella sp., Porphyromonas sp., Fusobacterium nucleatum, and Peptostreptococcus sp. Concordance in the microbiological findings between periapical abscess and the maxillary sinus flora was found in all instances. However, certain organisms were only present at one site and not the other. Five beta-lactamase-producing organisms were present in the five specimens. These data confirm the importance of anaerobic bacteria in periapical abscesses and demonstrate their predominance in maxillary sinusitis that is associated with them.

PMID 8794972  J Periodontol. 1996 Jun;67(6):608-10. doi: 10.1902/jop.・・・
著者: Roderick P Venekamp, Matthew J Thompson, Gail Hayward, Carl J Heneghan, Chris B Del Mar, Rafael Perera, Paul P Glasziou, Maroeska M Rovers
雑誌名: Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008115. doi: 10.1002/14651858.CD008115.pub2. Epub 2011 Dec 7.
Abstract/Text BACKGROUND: Acute sinusitis is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion.
OBJECTIVES: To assess the effectiveness of systemic corticosteroids in relieving symptoms of acute sinusitis.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2011, which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects (DARE) and the NHS Health Economics Database, MEDLINE (1966 to June week 2, 2011) and EMBASE (January 2009 to June 2011).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed methodological quality of the trials and extracted data.
MAIN RESULTS: Four RCTs with a total of 1008 adult participants met our inclusion criteria. We judged studies to be of moderate methodological quality. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their 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 (NSAIDs) 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, risk ratio (RR) 1.4, 95% CI 1.1 to 1.8; risk difference (RD) 20% (6% to 34%) and at Days 4 to 10 or 12, RR 1.3, 95% CI (1.0 to 1.7), RD 18% (3% to 33%). An analysis of the three trials with placebo as a control treatment showed similar results but with a lesser effect size: Days 3 to 6: RR 1.2, 95% CI (1.1 to 1.4), RD 12% (5% to 19%) and Days 4 to 10 or 12: RR 1.1, 95% CI (1.0 to 1.2), RD 10% (3% to 16%). Scenario analysis showed that outcomes missing from the trial reports might have introduced attrition bias (a worst-case scenario showed no statistically significant beneficial effect of oral corticosteroids). We did not identify any data on the long-term effects of oral corticosteroids on this condition, such as effects on relapse or recurrence rates. Reported side effects of oral corticosteroids were limited and mild.
AUTHORS' CONCLUSIONS: Current evidence suggests that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis. However, data are limited and there is a significant risk of bias. High quality trials assessing the efficacy of systemic corticosteroids both as an adjuvant and a monotherapy in primary care patients with acute sinusitis should be initiated.

PMID 22161418  Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008115. d・・・
著者: Roderick P Venekamp, Matthew J Thompson, Maroeska M Rovers
雑誌名: JAMA. 2015 Mar 24-31;313(12):1258-9. doi: 10.1001/jama.2014.14418.
Abstract/Text CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)?
BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest benefit for short-term relief of symptoms in adults with severe symptoms of acute sinusitis compared with antibiotics alone. Oral corticosteroids as monotherapy are not associated with improved clinical outcomes in adults with clinically diagnosed acute sinusitis.

PMID 25803348  JAMA. 2015 Mar 24-31;313(12):1258-9. doi: 10.1001/jama.・・・
著者: Jessica C Kassel, David King, Geoffrey Kp Spurling
雑誌名: Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006821. doi: 10.1002/14651858.CD006821.pub2. Epub 2010 Mar 17.
Abstract/Text BACKGROUND: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation, and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and mucolytic drugs, and often antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for chronic or allergic sinusitis, but little is known about its effect on acute URTIs.
OBJECTIVES: To evaluate the efficacy of saline nasal irrigation in treating the symptoms of acute URTIs.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to May 2009), EMBASE (1974 to May 2009), CINAHL (1982 to May 2009), AMED (1985 to 2009) and LILACS (May 2009).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.
DATA COLLECTION AND ANALYSIS: Two review authors (DK, GS) independently assessed trial quality and extracted data. All data were analysed using Cochrane Review Manager software.
MAIN RESULTS: Three RCTs (618 participants) were included. Most results showed no difference between nasal saline treatment and control. However, there was limited evidence of benefit with nasal saline irrigation in adults. One study showed a mean difference of 0.3 day (out of eight days) for symptom resolution, but this was not significant. Nasal saline irrigation was associated with less time off work in one study. Minor discomfort was not uncommon and 40% of babies did not tolerate nasal saline drops.
AUTHORS' CONCLUSIONS: Included trials were too small and had too high a risk of bias to be confident about the possible benefits of nasal saline irrigation in acute URTIs. Future trials should involve much larger numbers of participants and be rigorously designed and controlled.

PMID 20238351  Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006821. d・・・
著者: Ahmed Ragab, Taghreed Farahat, Ghada Al-Hendawy, Rehab Samaka, Seham Ragab, Amira El-Ghobashy
雑誌名: Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2178-86. doi: 10.1016/j.ijporl.2015.09.045. Epub 2015 Oct 22.
Abstract/Text OBJECTIVES: Acute rhinosinusitis (ARS) is a common pediatric problem. Our aim was to determine the efficacy of normal nasal saline irrigation (NSI) with or without amoxicillin in treatment of acute rhinosinusitis (ARS) in children.
METHODS: It is a prospective randomized, blind placebo-controlled trial. Children with uncomplicated ARS were recruited. One group received (amoxacillin 100mg/kg/day) and 0.9% NSI. The second group received placebo and 0.9% NSI. The primary outcome was the effect of treatment on clinical response. Secondary outcomes included: Rating of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), middle meatus (MM) bacteriological and cytological cellular responses and adverse effects.
RESULTS: Sixty two patients with ARS were eligible for the study. In amoxicillin group (31 patients); clinical cure was observed in 26 (83.9%) in comparison to 22 (71%) patients in NSI without antibiotics group (31 patients) (p=0.22). No differences between both groups in the reported nasal symptom scores and total symptoms scores improvements at day 7 (p=0.09 and 0.65) and day 14 (p=0.29 and 0.14), respectively. The mean total PRQLQ values had no differences between both groups after the 2 weeks of treatment (p=0.06). At day 7, MM neutrophils reduced significantly in amoxicillin group in comparison to placebo group (p=0.004). At day 14, the MM cytological content had no differences between both groups (p=0.07). Normal NSI with placebo has less reported adverse effects than amoxicillin and nasal saline irrigations (p=0.005).
CONCLUSIONS: NSI can be used alone with the same clinical, bacteriological and cytological cellular changes efficacy and with higher safety profile than amoxicillin after 14 days of treatment in uncomplicated clinically diagnosed ARS in children.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
PMID 26514931  Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2178-86・・・
著者: Jittima Veskitkul, Pakit Vichyanond, Punchama Pacharn, Nualanong Visitsunthorn, Orathai Jirapongsananuruk
雑誌名: Asian Pac J Allergy Immunol. 2015 Dec;33(4):276-80. doi: 10.12932/AP0591.33.4.2015.
Abstract/Text OBJECTIVE: Recurrent acute rhinosinusitis (RARS) is defined as multiple episodes of acute rhinosinusitis in which the symptoms and signs of infection resolve completely between episodes. Limited data are available on the characteristics and preventive therapy of RARS. This study evaluated the clinical characteristics and predisposing factors of RARS in children as well as the preventive therapy.
METHODS: Medical records of children with RARS diagnosed between January 2010 and December 2012 were obtained. Demographic data, presenting symptoms, predisposing factors and preventive therapy were reviewed.
RESULTS: Ninety-four children with RARS were recruited. The mean age was 7.7±2.6 years, with a mean age of onset of 4.0±1.4 years. Sixty-one patients (64.9%) were boys and 56 patients (59.6%) had family history of atopy. The most common presenting symptom of RARS was purulent nasal discharge (100.0%), followed by nasal congestion (68.1%) and postnasal drainage (31.9%). The most common predisposing factor for RARS was immunoglobulin G subclass deficiency (78.7%), followed by non-allergic rhinitis (64.9%) and allergic rhinitis (35.1%). Sixty-five children (69.1%) received preventive therapy for RARS. The responses to preventive measures were: 80.0% (32/40 patients) to oral antibiotic prophylaxis, 50.0% (11/22 patients) to adenotonsillectomy, 91.7% (11/12 patients) to specific allergen immunotherapy, 27.3% (3/11 patients) to gentamicin nasal irrigation, and 66.7% (4/6 patients) to intravenous immunoglobulin.
CONCLUSION: The most common presenting symptoms of RARS in children were purulent nasal discharge, nasal congestion and postnasal drainage. Children with RARS should be evaluated for the presence of underlying conditions such as immunodeficiency and allergic disease, which led to the appropriate management for these children.

PMID 26708390  Asian Pac J Allergy Immunol. 2015 Dec;33(4):276-80. doi・・・
著者: Richard M Rosenfeld, David Andes, Neil Bhattacharyya, Dickson Cheung, Steven Eisenberg, Theodore G Ganiats, Andrea Gelzer, Daniel Hamilos, Richard C Haydon, Patricia A Hudgins, Stacie Jones, Helene J Krouse, Lawrence H Lee, Martin C Mahoney, Bradley F Marple, Col John P Mitchell, Robert Nathan, Richard N Shiffman, Timothy L Smith, David L Witsell
雑誌名: Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31. doi: 10.1016/j.otohns.2007.06.726.
Abstract/Text OBJECTIVE: This guideline provides evidence-based recommendations on managing sinusitis, defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States, resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity, the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis, evaluated in any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis.
PURPOSE: The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis, reduce inappropriate antibiotic use, reduce inappropriate use of radiographic imaging, and promote appropriate use of ancillary tests that include nasal endoscopy, computed tomography, and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology-head and neck surgery, pulmonology, and radiology.
RESULTS: The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain. The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected. The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures. The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3 degrees C or 101 degrees F) and assurance of follow-up, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis.
DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance for managing adults with rhinosinusitis. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

PMID 17761281  Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31・・・
著者: O Berg, C Carenfelt
雑誌名: Acta Otolaryngol. 1988 Mar-Apr;105(3-4):343-9.
Abstract/Text One hundred and fifty-five patients with complaints indicating acute sinusitis were examined and their symptoms and signs registered. The final diagnosis--maxillary sinus empyema versus not empyema--was established by means of antral aspiration. A computer-based analysis of clinical data demonstrated the significance of the clinical examination. Local symptoms such as pain and purulent rhinorrhea with unilateral predominance were particularly guiding, even in bilateral cases, while nasal obstruction, tenderness during percussion, and affected general condition were not. With an overall reliability of about 85%, appropriate therapy can be suggested based on the clinical findings alone.

PMID 3389120  Acta Otolaryngol. 1988 Mar-Apr;105(3-4):343-9.
著者: A Axelsson, U Runze
雑誌名: ORL J Otorhinolaryngol Relat Spec. 1976;38(5):298-308.
Abstract/Text Symptoms and signs of acute maxillary sinusitis have seldom been specifically analyzed. Since there is a gradual transition from rhinitis to sinusitis it can be expected that many symptoms are common for the two diseases. However, since sinusitis requires drainage measures and/or antibiotic treatment, both of which seldom are actual for rhinitis, the differential diagnosis is important. The present investigation confirms most of the symptoms presented previously in textbooks. However, most of these sympatoms which conventionally are supposed to indicate sinus disease were found to be just as common in radiologically normal sinuses and in sinuses with pronounced changes. The subjective or objective finding of purulent nasal secretion was more helpful in the differentiation between rhinitis and sinusitis. It appears that the patient's symptoms do not constitute a reliable diagnostic basis for the confident differentiation between the two diseases. The simplest and least discomfortable means of demonstrating sinusitis is by radiology.

PMID 1034250  ORL J Otorhinolaryngol Relat Spec. 1976;38(5):298-308.
著者: A Axelsson, U Runze
雑誌名: Ann Otol Rhinol Laryngol. 1983 Jan-Feb;92(1 Pt 1):75-7.
Abstract/Text Some of the most common symptoms and signs of acute maxillary sinusitis were graded and compared with the radiological findings during the course of the disease. Four different treatment modes were used in 176 patients. The radiological and the subjective findings did not differ among the groups, which consequently were evaluated as an entity. The radiographic results demonstrated that the healing course during the first 15 treatment days follows an even regression line. The subjective findings show a more marked improvement during the first five days than subsequently, and also a more rapid initial improvement than radiography shows. The cough symptom showed the slowest recovery subjectively and also compared most closely with radiological findings. Patients with sinusitis which did not show an initial healing radiographically also had more marked symptoms the fifth day, and vice versa: patients who showed less than average healing subjectively also showed a slower healing radiographically.

PMID 6824285  Ann Otol Rhinol Laryngol. 1983 Jan-Feb;92(1 Pt 1):75-7.・・・
著者: J W Williams, D L Simel, L Roberts, G P Samsa
雑誌名: Ann Intern Med. 1992 Nov 1;117(9):705-10.
Abstract/Text OBJECTIVE: To identify the most useful clinical examination findings for the diagnosis of acute and subacute sinusitis.
DESIGN: Prospective comparison of clinical findings with radiographs.
SETTING: General medicine clinics at a university-affiliated Veterans Affairs Medical Center.
PATIENTS: Two hundred forty-seven consecutive adult men with rhinorrhea (51%), facial pain (22%) , or self-suspected sinusitis (27%) (median age, 50 years; median duration of symptoms, 11.5 days).
MEASUREMENTS: Patients were examined by a principal investigator (86%) or by a staff general internist, internal medicine resident (postgraduate year 2 or 3), or physician assistant, all blinded to radiographic results. All examiners recorded the presence or absence of 16 historical items, 5 physical examination items, and the clinical impression for sinusitis (high, intermediate, or low probability). The criterion standard was paranasal sinus radiographs (4 views), which were interpreted by radiologists blinded to clinical findings.
RESULTS: Thirty-eight percent of patients meeting entrance criteria had sinusitis. Sensitivity, specificity, and likelihood ratios were measured for clinical items. Logistic regression analysis showed five independent predictors of sinusitis: maxillary toothache (odds ratio, 2.9), transillumination (odds ratio, 2.7), poor response to nasal decongestants or antihistamines (odds ratio, 2.4), colored nasal discharge reported by the patient (odds ratio, 2.2), or mucopurulence seen during examination (odds ratio, 2.9). THe overall clinical impression was more accurate than any single finding: high probability (likelihood ratio, 4.7, intermediate (likelihood ratio, 1.4), low probability (likelihood ratio, 0.4).
CONCLUSIONS: General internists, focusing on five clinical findings and their overall clinical impression, can effectively stratify male patients with sinus symptoms as having a high, intermediate, or low probability of sinusitis.

PMID 1416571  Ann Intern Med. 1992 Nov 1;117(9):705-10.
著者: W Fokkens, V Lund, C Bachert, P Clement, P Helllings, M Holmstrom, N Jones, L Kalogjera, D Kennedy, M Kowalski, H Malmberg, J Mullol, D Passali, H Stammberger, P Stierna, EAACI
雑誌名: Allergy. 2005 May;60(5):583-601. doi: 10.1111/j.1398-9995.2005.00830.x.
Abstract/Text
PMID 15813802  Allergy. 2005 May;60(5):583-601. doi: 10.1111/j.1398-99・・・
著者: Anthony W Chow, Michael S Benninger, Itzhak Brook, Jan L Brozek, Ellie J C Goldstein, Lauri A Hicks, George A Pankey, Mitchel Seleznick, Gregory Volturo, Ellen R Wald, Thomas M File, Infectious Diseases Society of America
雑誌名: Clin Infect Dis. 2012 Apr;54(8):e72-e112. doi: 10.1093/cid/cir1043. Epub 2012 Mar 20.
Abstract/Text Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.

PMID 22438350  Clin Infect Dis. 2012 Apr;54(8):e72-e112. doi: 10.1093/・・・
著者: J M Gwaltney, J O Hendley, G Simon, W S Jordan
雑誌名: JAMA. 1967 Nov 6;202(6):494-500.
Abstract/Text
PMID 4293015  JAMA. 1967 Nov 6;202(6):494-500.
著者: R R Casiano
雑誌名: Semin Respir Infect. 2000 Sep;15(3):216-26.
Abstract/Text Rhinosinusitis is a common health complaint that is often seen by primary care physicians and otolaryngologists in the United States. The complicated anatomy of the paranasal sinuses, as well as the multiple etiologies, contributes to the complexity that one often faces in trying to ameliorate or eradicate this disease in affected individuals. A full understanding of the fundamentals of rhinosinusitis, as well as the treatment options available for the different types, is important. It is very important for the physician to take an organized, step-by-step approach to the management of each patient with this complicated disease. As most cases of rhinosinusitis presenting to the generalist's office will be of viral origin, antibiotics should not be given unless the patient has purulent rhinorrhea or worsening symptoms lasting more than 5 days, or total symptoms lasting longer than 10 days. When medical treatment fails or is incomplete, adjunctive surgical treatment becomes an option. Generally, the symptoms that are most helped by surgery include persistent headaches, nasal obstruction, and recurrent or persistent purulent rhinorrhea unresponsive to medical management. Appropriate and timely referral for specialty care will result in the definitive management of recalcitrant rhinosinusitis when medical management alone fails or in cases where a complication or malignancy is suspected. This article reviews the current understanding of the anatomy, pathophysiology, classification, diagnosis, and potential complications of rhinosinusitis. It also describes the current approach to the treatment of both acute and chronic rhinosinusitis.

PMID 11052422  Semin Respir Infect. 2000 Sep;15(3):216-26.
著者: Jim Young, An De Sutter, Dan Merenstein, Gerrit A van Essen, Laurent Kaiser, Helena Varonen, Ian Williamson, Heiner C Bucher
雑誌名: Lancet. 2008 Mar 15;371(9616):908-14. doi: 10.1016/S0140-6736(08)60416-X.
Abstract/Text BACKGROUND: Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. 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.
METHODS: We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials. Individual patients' data from 2547 adults in nine trials were checked and re-analysed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needed to treat (NNT) with antibiotics to cure one additional patient.
FINDINGS: 15 patients with rhinosinusitis-like complaints would have to be given antibiotics before an additional patient was cured (95% CI NNT[benefit] 7 to NNT[harm] 190). Patients with purulent discharge in the pharynx took longer to cure than those without this sign; the NNT was 8 patients with this sign before one additional patient was cured (95% CI NNT[benefit] 4 to NNT[harm] 47). Patients who were older, reported symptoms for longer, or reported more severe symptoms also took longer to cure but were no more likely to benefit from antibiotics than other patients.
INTERPRETATION: Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.

PMID 18342685  Lancet. 2008 Mar 15;371(9616):908-14. doi: 10.1016/S014・・・
著者: Jane M Garbutt, Christina Banister, Edward Spitznagel, Jay F Piccirillo
雑誌名: JAMA. 2012 Feb 15;307(7):685-92. doi: 10.1001/jama.2012.138.
Abstract/Text CONTEXT: Evidence to support antibiotic treatment for acute rhinosinusitis is limited, yet antibiotics are commonly used.
OBJECTIVE: To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute rhinosinusitis.
DESIGN, SETTING, AND PARTICIPANTS: A randomized, placebo-controlled trial of adults with uncomplicated, acute rhinosinusitis were recruited from 10 community practices in Missouri between November 1, 2006, and May 1, 2009.
INTERVENTIONS: Ten-day course of either amoxicillin (1500 mg/d) or placebo administered in 3 doses per day. All patients received a 5- to 7-day supply of symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed.
MAIN OUTCOME MEASURES: The primary outcome was improvement in disease-specific quality of life after 3 to 4 days of treatment assessed with the Sinonasal Outcome Test-16 (minimally important difference of 0.5 units on a 0-3 scale). Secondary outcomes included the patient's retrospective assessment of change in sinus symptoms and functional status, recurrence or relapse, and satisfaction with and adverse effects of treatment. Outcomes were assessed by telephone interview at days 3, 7, 10, and 28.
RESULTS: A total of 166 adults (36% male; 78% with white race) were randomized to amoxicillin (n = 85) or placebo (n = 81); 92% concurrently used 1 or more symptomatic treatments (94% for amoxicillin group vs 90% for control group; P = .34). The mean change in Sinonasal Outcome Test-16 scores was not significantly different between groups on day 3 (decrease of 0.59 in the amoxicillin group and 0.54 in the control group; mean difference between groups of 0.03 [95% CI, -0.12 to 0.19]) and on day 10 (mean difference between groups of 0.01 [95% CI, -0.13 to 0.15]), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19 [95% CI, 0.024 to 0.35]). There was no statistically significant difference in reported symptom improvement at day 3 (37% for amoxicillin group vs 34% for control group; P = .67) or at day 10 (78% vs 80%, respectively; P = .71), whereas at day 7 more participants treated with amoxicillin reported symptom improvement (74% vs 56%, respectively; P = .02). No between-group differences were found for any other secondary outcomes. No serious adverse events occurred.
CONCLUSION: Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00377403.

PMID 22337680  JAMA. 2012 Feb 15;307(7):685-92. doi: 10.1001/jama.2012・・・
著者: Richard M Rosenfeld, Jay F Piccirillo, Sujana S Chandrasekhar, Itzhak Brook, Kaparaboyna Ashok Kumar, Maggie Kramper, Richard R Orlandi, James N Palmer, Zara M Patel, Anju Peters, Sandra A Walsh, Maureen D Corrigan
雑誌名: Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39. doi: 10.1177/0194599815572097.
Abstract/Text OBJECTIVE: This update of a 2007 guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation provides evidence-based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS).
PURPOSE: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia.
ACTION STATEMENTS: The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.

© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
PMID 25832968  Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S3・・・
著者: Eli O Meltzer, Claus Bachert, Heribert Staudinger
雑誌名: J Allergy Clin Immunol. 2005 Dec;116(6):1289-95. doi: 10.1016/j.jaci.2005.08.044. Epub 2005 Oct 24.
Abstract/Text BACKGROUND: Intranasal corticosteroids used with antibiotics are known to improve rhinosinusitis symptoms compared with antibiotic therapy alone. However, the efficacy of intranasal corticosteroid monotherapy for acute, uncomplicated rhinosinusitis is not established.
OBJECTIVES: To evaluate efficacy and safety of mometasone furoate nasal spray (MFNS) versus amoxicillin and placebo in patients with acute, uncomplicated rhinosinusitis.
METHODS: In this double-blind, double-dummy trial, subjects (> or =12 years; N = 981) were randomized to MFNS 200 microg once daily or twice daily for 15 days, amoxicillin 500 mg 3 times daily for 10 days, or respective placebo. Follow-up was 14 days. The primary efficacy endpoint was mean am/pm major symptom score over the treatment phase. Secondary efficacy endpoints included total symptom score. Safety assessments included disease recurrence during follow-up and adverse event monitoring.
RESULTS: Mometasone furoate nasal spray 200 microg twice daily was significantly superior to placebo (P < .001) and amoxicillin (P = .002) at improving major symptom score. Starting on day 2, MFNS 200 microg twice daily improved total symptom score throughout treatment versus amoxicillin (P = .012) and placebo (P < .001). Global response to treatment was significantly greater with MFNS 200 microg twice daily versus amoxicillin (P = .013) and placebo (P = .001). Although significantly superior to placebo, MFNS 200 microg once daily was not superior to amoxicillin for the primary or secondary efficacy endpoints. All treatments were well tolerated with a similar incidence of adverse events.
CONCLUSION: In patients with acute, uncomplicated rhinosinusitis, MFNS 200 microg twice daily produced significant symptom improvements versus amoxicillin and placebo, without predisposing the patient to disease recurrence or bacterial infection.

PMID 16337461  J Allergy Clin Immunol. 2005 Dec;116(6):1289-95. doi: 1・・・
著者: I B Barlan, E Erkan, M Bakir, S Berrak, M M Başaran
雑誌名: Ann Allergy Asthma Immunol. 1997 Jun;78(6):598-601. doi: 10.1016/S1081-1206(10)63223-1.
Abstract/Text BACKGROUND: The role of topical corticosteroids in the treatment of acute sinusitis has not been established in children.
OBJECTIVE: An attempt was made to determine the impact of topical corticosteroids as an adjunct to antibiotic treatment in the management of childhood sinusitis.
METHODS: In a double-blind, placebo-controlled study, 151 children with sinusitis were recruited from a general pediatric outpatient clinic and 89 completed a 3-week trial. Treatment consisted of amoxicillin-clavulanate potassium, 40 mg/kg/d tid, combined with bid nasal spray of either budesonide, 50 micrograms, to each nostril (n = 43) or placebo )n = 46_ for 3 weeks. Patients maintained daily symptom cards throughout the study and were examined by the same physician each week.
RESULTS: Clinical symptoms and signs decreased significantly in both treatment groups in comparison to baseline (P < .01). We detected a significant improvement in the scores of the cough and nasal discharge at the end of second week in the budesonide group when compared with placebo (P < .05). Friedman nonparametric repeated measures ANOVA test revealed a significant decrease in the total weekly scores of cough during the second week of budesonide treatment (P < .001) in contrast to continuous decline during the second and third weeks in the placebo group (P < .001 and P < .05, respectively). While the nasal discharge score decreased significantly during the second week in the budesonide group (P < .01), no significant effect on the nasal discharge score was observed in the placebo group.
CONCLUSION: These data suggest that topical corticosteroids may be a useful ancillary treatment to antibiotics in childhood sinusitis and effective in reducing the cough and nasal discharge earlier in the course of acute sinusitis.

PMID 9207726  Ann Allergy Asthma Immunol. 1997 Jun;78(6):598-601. doi・・・
著者: G Yilmaz, B Varan, T Yilmaz, B Gürakan
雑誌名: Eur Arch Otorhinolaryngol. 2000;257(5):256-9.
Abstract/Text We investigated the clinical value of intranasal budesonide in acute sinusitis in 52 children with acute maxillary sinusitis. We randomly divided them into two groups: group 1 received oral pseudoephedrine (2 x 30 mg) and cefaclor (40 mg/kg) for 10 days, and group 2 received intranasal budesonide (2 x 100 microg) and cefaclor (40 mg/kg) for 10 days. Symptoms of headache, cough, and nasal stuffiness and signs of nasal discharge were graded before and after treatment. The patients whose symptoms and signs completely normalized after treatment were considered to have recovered, and those with persisting symptoms and signs after treatment as having not recovered. The results of the two treatment groups were compared. The recovery rate of the children in group 2 were significantly higher than those in group 1 (P < 0.05). No adverse drug effects were determined during the study period. These findings suggest that topical steroids may be a useful adjunctive agent in the treatment of acute sinusitis of children without apparent side effects and can possibly hasten the resolution of symptoms.

PMID 10923938  Eur Arch Otorhinolaryngol. 2000;257(5):256-9.
著者: Claus Bachert, Eli O Meltzer
雑誌名: Rhinology. 2007 Sep;45(3):190-6.
Abstract/Text This study evaluated the effect of mometasone furoate nasal spray (MFNS) on health-related quality of life (HRQoL) in patients with acute, uncomplicated rhinosinusitis. In a randomized, double-blind, placebo-controlled trial, HRQoL was assessed in 340 patients using the SinoNasal Outcome Test (SNOT)-20 questionnaire at baseline and after 15 days of treatment with MFNS 200 g once-daily (q.d.) or twice-daily (b.i.d.), amoxicillin 500 mg three times daily (t.i.d.), or placebo. Baseline mean total scores for SNOT-20 were similar in the four groups (2.15-2.23). At endpoint, there was a statistically significant improvement in mean total score only with MFNS 200 g b.i.d. (p = 0.047 versus placebo). MFNS was associated with numerical improvements in all SNOT-20 items compared with placebo. Treatment with MFNS 200 g b.i.d. is associated with a significant improvement in HRQoL compared with placebo in patients with acute, uncomplicated rhinosinusitis.

PMID 17956016  Rhinology. 2007 Sep;45(3):190-6.
著者: S P Stringer, A A Mancuso, A J Avino
雑誌名: Laryngoscope. 1993 Jan;103(1 Pt 1):6-9. doi: 10.1288/00005537-199301000-00002.
Abstract/Text Apparent ethmoid inflammation which resolved with alternation of the nasal cycle or following application of topical vasoconstrictors has been observed with magnetic resonance imaging. A similar phenomenon might occur to a lesser degree with computed tomography (CT), leading to overdiagnosis of limited sinus disease. The degree to which ostiomeatal complex disease is reversible by topical vasoconstrictors was investigated. Ten patients with histories of chronic or recurrent sinusitis underwent coronal CT studies of the paranasal sinuses before and after the application of a topical vasoconstrictor. Mucosal volume or thickness measurements were obtained from the turbinates, infundibulum, ethmoidal cells, and antrum. Vasoconstrictor application markedly reduced turbinate size and appeared to reduce mucosal thickening in the ethmoidal infundibulum. Minimal mucosal changes identified in the paranasal sinuses by computed tomography were not reversed by vasoconstrictors and therefore are likely to be pathologic.

PMID 8421421  Laryngoscope. 1993 Jan;103(1 Pt 1):6-9. doi: 10.1288/00・・・
著者: Selçuk Inanli, Ozmen Oztürk, Mukadder Korkmaz, Alper Tutkun, Cağlar Batman
雑誌名: Laryngoscope. 2002 Feb;112(2):320-5. doi: 10.1097/00005537-200202000-00022.
Abstract/Text OBJECTIVES: The aims of the study were to determine: 1) how mucociliary activity in acute bacterial rhinosinusitis is affected; 2) how this activity is changed by therapy; 3) the effects of topical agents on mucociliary clearance, and 4) the most appropriate topical agent(s) to be used in the therapy of sinusitis.
STUDY DESIGN: Five groups of patients with acute bacterial rhinosinusitis were studied prospectively.
METHODS: All patients had 500 mg oral amoxicillin and 125 mg oral clavulanic acid preparations given three times daily for 3 weeks. According to the topical agent applications, these groups included: group I (n = 12), no topical treatment was given; group II (n = 14), two puffs for each nostril once daily of 50 microg/100 mL fluticasone propionate was given; group III (n = 9), one puff for each nostril three times daily of 0.05% oxymetazoline was given; group IV (n =12), 3% sodium chloride (NaCl) (buffered to pH 6.5-7 at room temperature) was given; and group V (n =13), 10-mL solutions of 0.9% NaCl (buffered to pH 6.5--7 at room temperature) were given for nasal irrigations three times daily. All patients had medication for 3 weeks and were controlled each week. The saccharin method was used to measure nasal mucociliary clearance. To investigate the early effects of the topical agents for groups II to V, an additional test was repeated 20 minutes after the basal mucociliary clearance recordings. The test was repeated in the first, second, and third weeks of the treatment.
RESULTS: The mucociliary clearance was significantly slower in the acute bacterial rhinosinusitis group than in the control group. There was no significant difference between the basal mucociliary clearance and the 20th minute mucociliary clearance of the fluticasone propionate and 0.9% NaCl solution groups. The mean values of the basal and the 20 minute's mucociliary clearance of the oxymetazoline group were 24.72 +/- 6.16 and 15.5 +/- 7.45 minutes, respectively, which were statistically significant. The mean values of the basal and the 20th minute mucociliary clearance of the 3% NaCl solution groups were 19.45 +/- 9.35 and 15.45 +/- 8.20 minutes, respectively, which were also statistically significant. In the first group (without topical treatment), the basal mucociliary clearance became significantly shorter after the second week of treatment. In the first and second weeks of the treatment of the oxymetazoline group, the mucociliary clearance did not change significantly, but after the third week the mucociliary clearance was significantly shorter. In the 3% NaCl solution group, significant improvement began from the first week and continued through the third week. Comparing the basal and the third weeks' mucociliary clearance values among the groups, the oxymetazoline and 3% NaCl solution groups revealed more significant improvement than the other groups, but this improvement was not different from the improvement of group I. There was still a statistically significant difference in the mucociliary clearance of the post-treatment sinusitis groups from the control group.
CONCLUSIONS: The oxymetazoline and 3% NaCl solution groups seemed to be more effective in mucociliary clearance, but there was no significant difference in improvement among the groups. The improvement of acute bacterial rhinosinusitis takes more than 3 weeks, according to the mucociliary clearance values of the groups.

PMID 11889391  Laryngoscope. 2002 Feb;112(2):320-5. doi: 10.1097/00005・・・
著者: L Wiklund, P Stierna, R Berglund, K M Westrin, M Tönnesson
雑誌名: Acta Otolaryngol Suppl. 1994;515:57-64.
Abstract/Text The efficacy of a new administration form of oxymetazoline, a nasal bellows container, was investigated in two separate studies by means of a combined treatment with phenoxymethyl-penicillin for acute maxillary sinusitis. In the first study (study 1), oxymetazoline administered with a bellows (OXBE) was compared both with a placebo belows (PLBE) as well as with oxymetazoline and placebo administered with a conventional nasal spray (OXSP respective PLSP) in 73 patients. In the second study (study 2), OXBE was compared only with PLBE in 48 patients. Objective evaluation was made by comparing the radiographical improvement in conventional plain sinus X-ray images. A scoring system corresponding to the outcome of antral irrigation was used for evaluating the X-ray pictures. Subjective symptoms; nasal stuffiness and pain, were assessed by registrations on visual analogue scales. Neither with regard to radiographical improvement nor to decrease in subjective symptoms could any significant differences be found between the different treatment modes. Oxymetazoline administered with a nasal bellows thus did not accelerate the rate of healing of acute maxillary sinusitis in these two studies. It is inferred from these results that decongestion of the sinus ostia is not of primary importance for the course of healing of a manifest acute sinusitis.

PMID 8067245  Acta Otolaryngol Suppl. 1994;515:57-64.
著者: Dewey C Scheid, Robert M Hamm
雑誌名: Am Fam Physician. 2004 Nov 1;70(9):1697-704.
Abstract/Text Although most cases of acute rhinosinusitis are caused by viruses, acute bacterial rhinosinusitis is a fairly common complication. Even though most patients with acute rhinosinusitis recover promptly without it, antibiotic therapy should be considered in patients with prolonged or more severe symptoms. To avoid the emergence and spread of antibiotic-resistant bacteria, narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days. In patients with mild disease who have beta-lactam allergy, trimethoprim/sulfamethoxazole or doxycycline are options. Second-line antibiotics should be considered if the patient has moderate disease, recent antibiotic use (past six weeks), or no response to treatment within 72 hours. Amoxicillin-clavulanate potassium and fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae. In patients with beta-lactam hypersensitivity who have moderate disease, a fluoroquinolone should be prescribed. The evidence supporting the use of ancillary treatments is limited. Decongestants often are recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion. Topical ipratropium and the sedating antihistamines have anticholinergic effects that maybe beneficial, but there are no clinical studies supporting this possibility. Nasal irrigation with hypertonic and normal saline has been beneficial in chronic sinusitis and has no serious adverse effects. Nasal corticosteroids also may be beneficial in treating chronic sinusitis. Mist, zinc salt lozenges, echinacea extract, and vitamin C have no proven benefit in the treatment of acute bacterial rhinosinusitis.

PMID 15554487  Am Fam Physician. 2004 Nov 1;70(9):1697-704.
著者: K S Wan, W F Wu, T C Chen, C S Wu, C W Hung, Y S Chang
雑誌名: Minerva Pediatr. 2015 Dec;67(6):489-94.
Abstract/Text AIM: Intranasal corticosteroids (INS) have been proven effective in controlling postnasal drip, decreasing inflammatory response, reducing nasal swelling, and increasing aeration of the sinuses such that INS are recommended as treatment of sinusitis.
METHODS: Fifty children with acute rhinosinusitis, 50 children with acute rhiniosinusitis and allergic rhinitis (AR), and 20 rhiniosinusitis children as control were selected for investigation. Each group had a single-blind treatment of three types: with coamoxiclav only, with coamoxiclav plus INS, and with matched placebo (without antibiotics and INS) for two weeks. Nasal symptoms were then evaluated. The outcome was measured by using major symptom score (MSS) after treatment for 14 days.
RESULTS: Therapeutic effectiveness was 92% in rhinosinusitis patients treated with co-amoxiclav and 84% in those treated with co-amoxiclav plus INS. Among patients with sinusitis combined with AR, therapeutic efficacy was 88% for those treated with co-amoxiclav and 96% for those treated with co-amoxiclav plus INS. Only 30% of the symptoms were reduced in the placebo group.
CONCLUSION: There are no statistical differences in the acute sinusitis group treated with co-amoxiclav with or without INS. In the sinusitis with AR group, the efficacy of co-amoxiclav with INS is higher than in children treated with co-amoxiclav alone.

PMID 26530491  Minerva Pediatr. 2015 Dec;67(6):489-94.
著者: Matthew E Falagas, Drosos E Karageorgopoulos, Alexandros P Grammatikos, Dimitrios K Matthaiou
雑誌名: Br J Clin Pharmacol. 2009 Feb;67(2):161-71. doi: 10.1111/j.1365-2125.2008.03306.x. Epub 2008 Sep 19.
Abstract/Text WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Treatment guidelines generally support that a 10-14-day antibiotic regimen should be administered to uncomplicated acute bacterial sinusitis patients. However, the level of evidence for such a recommendation is rather weak. Treatment of such duration may have disadvantages compared with a shorter duration but equally effective regimen, including the promotion of bacterial drug resistance, poorest patient compliance, higher toxicity, and a greater overall economic burden.
WHAT THIS STUDY ADDS: The findings of this meta-analysis suggest that short-course antibiotic treatment has similar effectiveness to longer-course treatment for patients with acute uncomplicated bacterial sinusitis, when treatment is warranted. However, we should underscore the importance of the clinician's own assessment, so that antimicrobial therapy should not inappropriately be curtailed in a patient not adequately responding to the regimen administered. We sought to evaluate the effectiveness and safety of short-course antibiotic treatment for acute bacterial sinusitis (ABS) compared with longer duration treatment. We performed a meta-analysis of randomized controlled trials (RCTs), identified by searching PubMed and the Cochrane Central Register of Controlled Trials. We included RCTs that compared short-course (up to 7 days) vs. long-course therapy (> or =2 days longer than short-course), with the same antimicrobial agent, in the same daily dosage, for patients with ABS. Twelve RCTs (10 double-blinded) involving adult patients with radiologically confirmed ABS were included. There was no difference in the comparison of short-course (3-7 days) with long-course treatment (6-10 days) regarding clinical success [12 RCTs, 4430 patients, fixed effect model (FEM), odds ratio (OR) 0.95, 95% confidence interval (CI) 0.81, 1.12]; microbiological efficacy; relapses; adverse events (10 RCTs, 4172 patients, random effects model, OR 0.88, 95% CI 0.71, 1.09); or withdrawals due to adverse events. In the sensitivity analysis comparing 5- vs. 10-day regimens, clinical success was similar, although adverse events were fewer with short-course treatment (5 RCTs, 2151 patients, FEM, OR 0.79, 95% CI 0.63, 0.98). Although antibiotics for acute sinusitis should be reserved for select patients with substantial probability of bacterial disease, accurate clinical diagnosis is often difficult to attain. Short-course antibiotic treatment had comparable effectiveness to a longer course of therapy for ABS. Shortened treatment, particularly for patients without severe disease and complicating factors, might lead to fewer adverse events, better patient compliance, lower rates of resistance development and fewer costs.

PMID 19154447  Br J Clin Pharmacol. 2009 Feb;67(2):161-71. doi: 10.111・・・
著者: S Albu, E Tomescu, S Bassam, Z Merca
雑誌名: Acta Otorhinolaryngol Belg. 2001;55(4):265-72.
Abstract/Text OBJECTIVE: The aim of this study was to discuss the presenting signs and symptoms important for the early diagnosis and to review the medical and surgical management of patients presenting with intracranial complications of sinusitis.
METHODS: Retrospective review of the medical records of all patients admitted with intracranial infections between 1990 and 1999 at the Department of Otolaryngology, Department of Neurosurgery and Department of Infectious Diseases, University of Cluj, Romania.
RESULTS: Sixteen patients had 23 intracranial complications of sinusitis. These were meningitis (6 cases), frontal lobe abscess (6 cases), epidural abscess (5 cases), subdural abscess (4 cases), and cavernous sinus thrombophlebitis (2 cases). In almost all patients, early symptoms included headache and fever. Clinical diagnosis was confirmed by imaging. Management of these infections included intravenous broad-spectrum antibiotics, appropriate neurosurgical and sinus drainage. Among these patients, there was one death and 4 patients developed significant neurologic sequelae. Poor prognosis was associated with the presence of subdural abscess and a prolonged time interval between the onset of symptoms and the beginning of treatment.
CONCLUSION: Early diagnosis of intracranial complication of sinusitis can reduce morbidity and mortality associated with these complications.

PMID 11859644  Acta Otorhinolaryngol Belg. 2001;55(4):265-72.
著者: N S Jones, J L Walker, S Bassi, T Jones, J Punt
雑誌名: Laryngoscope. 2002 Jan;112(1):59-63. doi: 10.1097/00005537-200201000-00011.
Abstract/Text OBJECTIVES/HYPOTHESIS: Reference textbooks on the intracranial complications of rhinosinusitis imply that many of the intracranial complications of rhinosinusitis can be prevented. We sought to examine whether or not this is true.
STUDY DESIGN: A retrospective case series.
METHODS: The study included 47 consecutive patients presenting with intracranial complications secondary to rhinosinusitis between 1992 to 1999 with a mean follow-up of 5 years and 1 month.
RESULTS: The most common presenting symptoms of intracranial involvement were an altered mental state, headache, fever, seizure, vomiting, a unilateral weakness or hemiparesis, or a cranial nerve sign. These justify an urgent magnetic resonance imaging or computed tomography scan. The importance of imaging before a lumbar puncture cannot be overemphasized. Of particular note was the finding that 21 patients (45%) presented with a periorbital cellulitis or frontal swelling. Therefore, it does not follow that because a collection of pus presents anteriorly it precludes any intracranial involvement. More than half of our patients (55%) had visited their primary care physician with an upper respiratory tract infection and had been treated appropriately. Once any central symptoms or signs developed, there was little evidence of any significant delay in referral to our unit. Only six patients had a history of nasal disease, three having had recent sinus surgery and three having had nasal polyps. Nine patients had significant long-term morbidity, seven patients had epilepsy, one patient had dysphasia, and one patient had right arm weakness. The single death in our series was associated with a cavernous sinus thrombosis.
CONCLUSIONS: The report emphasizes the need for surgeons to be alert to the diagnosis, particularly in patients with a periorbital abscess or frontal swelling. Sinus surgery has a role in obtaining pus for culture, as well as draining the sinus if it is in continuity with an intracranial collection. Intracranial infections secondary to rhinosinusitis occur sporadically and, although it appears that this cannot be prevented, early recognition and treatment are essential to reduce any subsequent morbidity or mortality.

PMID 11802039  Laryngoscope. 2002 Jan;112(1):59-63. doi: 10.1097/00005・・・
著者: L Berenholz, A Kessler, N Shlomkovitz, S Sarfati, S Segal
雑誌名: Arch Otolaryngol Head Neck Surg. 1998 Jan;124(1):95-7.
Abstract/Text
PMID 9440788  Arch Otolaryngol Head Neck Surg. 1998 Jan;124(1):95-7.
著者: A Ali, M Kurien, S S Mathews, J Mathew
雑誌名: Singapore Med J. 2005 Oct;46(10):540-4.
Abstract/Text INTRODUCTION: Complications of acute infective sinusitis are a therapeutic emergency. The purpose of this study was to determine the clinical presentation, microbiological pattern, treatment modalities and outcome of patients diagnosed to have acute rhinogenic orbital, intra- and extra-cranial complications from a developing country in Asia.
METHODS: A retrospective chart review from October 1999 to January 2004 was conducted.
RESULTS: Among 247 ENT surgical emergencies documented, 13 patients (5.3 percent) were diagnosed to have acute sinusitis with various complications either as in solitary or multiple forms. Orbital complications were the most common (61.5 percent) followed by acute subdural empyema (23.1 percent) and meningitis (15.2 percent). Subdural empyema was the most common intracranial complication. Staphylococcus was reported to be the most common offending organism (45.5 percent). Majority of the patients (84.6 percent) had surgical drainage of the affected sinuses, 38.5 percent being endoscopic drainage while external approach was done for those with coexisting osteomyelitis (30.8 percent). Two patients had combined approach, and one patient had post-operative facial paresis. There was no mortality in our series.
CONCLUSION: Early detection, aggressive medical and prompt surgical treatment by multidisciplinary approach involving ophthalmological, neurosurgical and rhinological procedures, can successfully treat the complications with a significant reduction in the morbidity and no mortality.

PMID 16172774  Singapore Med J. 2005 Oct;46(10):540-4.

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