Multi-Specialty Practice Guidelines for Adult Sinusitis Released By Leading Society of Ear, Nose, and Throat Physicians

Newswise — The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has issued multi-disciplinary, evidence-based practice guidelines for treating adult sinusitis, the common ailment that affects one in seven adults. Adult sinusitis has a profound impact on quality of life and workforce productivity, while costing the nation’s healthcare system over $5.8 billion annually.

The new practice guidelines outline the best way for physicians and other healthcare professionals to diagnose and manage sinusitis in adults.

“Sinusitis is responsible for more than one in five antibiotics prescribed in adults and 500,000 annual surgical procedures,” notes Richard Rosenfeld, MD, lead author of the guideline and chair of the guideline panel. “If we are to address the issue of over-prescribing antibiotics, it starts with setting guidelines for when it is proper to use antibiotics to treat patients’ most common ailments.”

The guidelines were developed with input from a wide array of medical specialties, including representatives from the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology – head and neck surgery, and radiology.

“It was critical to develop a set of guidelines that is not only based on sound science, but also to hear from those in the many specialties that have a stake in treating sinusitis in adults,” Rosenfeld said.

The guidelines emphasize appropriate diagnosis, and provide management options including observation, antibiotic therapy, and additional testing, including:

•Healthcare professionals should distinguish acute bacterial sinusitis from sinusitis caused by colds, viruses, and non-infectious conditions. Bacterial sinusitis is likely when the illness (a) is still present after 10 days or (b) worsens within 10 days after initial improvement (double worsening pattern).
•Acute sinusitis is diagnosed as up to four weeks of purulent (not clear) nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness, or both.
•X-rays are not recommended to diagnose acute sinusitis in most patients.
•Observation without antibiotics is a safe and effective management option for selected adults with acute sinusitis who have mild illness (mild pain and temperature <101oF) and assurance of follow-up.
•When antibiotics are prescribed, amoxicillin is recommended as first-line therapy
•Acute sinusitis may take up to seven days to improve, regardless of whether the initial therapy consists of observation or immediate antibiotics.
•Healthcare professionals should distinguish chronic sinusitis (lasting 12 weeks or longer) and recurrent acute sinusitis (four episodes per year without symptoms in between) from isolated episodes.
•Patients with chronic sinusitis or recurrent acute sinusitis should have computed tomography (CAT scan) of the sinuses; additionally, nasal endoscopy, allergy assessment, or both may also be obtained.
•Clinicians should educate/counsel patient with chronic sinusitis or recurrent acute sinusitis regarding control measures, which include smoking cessation and saline nasal irrigation.

The clinical practice guidelines apply to adults aged 18 years or older.

Clinical Practice Guideline on Adult Sinusitis will appear as a supplement to the September 2007 issue of Otolaryngology – Head and Neck Surgery, the peer-reviewed scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) and the American Academy of Otolaryngic Allergy. It will also be presented in seminar in Washington, DC, during the organization’s Annual Meeting and OTO Expo, to be held September 16-20, 2007.

About the AAO-HNS
The American Academy of Otolaryngology – Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: “Working for the Best Ear, Nose, and Throat Care.”