Sinusitis Guidelines – Alabama Nasal & Sinus Center

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Sinusitis Guidelines

Though not topping the headlines of your local newspaper or headlining the prime time shows on Fox News or CNN, the American Academy of Otolaryngology – Head and Neck Surgery just made news in the world of ear, nose, and throat specialists.  The Academy released its long awaited update to the clinical practice guideline for adult rhinosinusitis.  (Gasp!! Ooo! Ahhh!)  The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia.  An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

We ENT doctors get all geeked out on this stuff.  It’s what we do!  The full text of the guideline document is a hearty thirty-nine pages with essentially no pictures.  I read the whole thing.  Again, it’s what I do.  I would not suggest you, the non-professional try that at home, unless you are suffering from insomnia.  But, there are some things in there that will affect how we practice and thus will become important to you if you are or have been a patient who suffers acute sinusitis.  To begin, we should define some terms for everyone. 

                                                                     

Acute rhinosinusitis:  Up to 4 weeks of purulent (pus-like) nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain, or both.

Acute bacterial rhinosinusitis:  Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose acute bacterial rhinosinusitis when

  • Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and it may be reported by the patient or observed on physical examination.
  • Nasal obstructionmay be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or it may be diagnosed by physical examination.
  • Facial pain/pressure/fullness may involve the anterior face or periorbital region, or it may manifest with headache that is localized or diffuse.

 a. symptoms or signs of acute rhinosinusitis fail to improve within 10 days or more beyond the onset of upper respiratory symptoms

or

b. symptoms or signs of acute rhinosinusitis worsen within 10 d after an initial improvement (double worsening).  

Well, that’s probably enough for now.  Stay tuned for more definitions and explanation of our treatment rationale.  The take home message for today is that acute sinusitis can last up to four weeks and that antibiotics are not considered primary therapy until symptoms have been present for at least ten days.  Whoa!  That may seem like a long time when your head feels like it’s going to blow up.  Again, stay tuned.  We’ll talk more about this in future posts or when you come see us.  Call 205-980-2091 to schedule an appointment now. 

I am a general otolaryngologist who specializes in diagnosis and treatment of diseases affecting the ears, nose, and throat. Though I treat patients in all areas of otolaryngology, of all ages, I have special interests in rhinology, otolaryngic allergy, pediatric otolaryngology, and head and neck cancer.

I was born in Dothan, Alabama and spent my first two years in Troy, where my parents were completing school. Most of my early childhood and adolescence was spent in Pace, Florida, just East of Pensacola. I left home after graduating from Pace High School to attend the University of Florida. While there, I became very involved in various student leadership activities and even found time to play football for the Gators under Coach Spurrier. I loved college so much, I got two degrees and spent another two years in Gainesville while my new bride finished her degree in health science education. I am proudly married to the charming and beautiful Simone, mother of our three wonderful children.

I was pleased to get back to the Gulf Coast for a while when the University of South Alabama accepted me into their medical school. Those four years were some of the most intense and most fondly remembered years of my life. I started my training in otolaryngology – head and neck surgery at the University of Alabama Birmingham in 2001. I completed residency training in 2006 and began working in private practice in Valdosta, Georgia. It was while training at UAB that I met Dr. Michael Sillers. It is my great privilege to call Dr. Sillers my mentor and friend. We have known each other for over a decade now, and I am absolutely thrilled to have the opportunity to join Dr. Sillers and the Alabama Nasal and Sinus Center in providing the best in otolaryngology care to the people of Birmingham and surrounding areas.