Management of rhinosinusitis in adults in primary care

• Published in: Malaysian family physician Vol. 13; no. 1; pp. 28 - 33
• Main Authors: S, Husain, HH, Amilia, MN, Rosli, FD, Zahedi, IS, Sachlin
• Format: Journal Article
• Language: English
• Published: Kuala Lumpur Academy of Family Physicians of Malaysia 2018; Academy of Family Physician of Malaysia
• Subjects: Antibiotics; Bacterial infections; Clinical medicine; Cold remedies; Cpg Update; Diabetes; Edema; Endoscopy; Family medical history; HIV; Human immunodeficiency virus; Inflammation; Medical imaging; Nose; Otolaryngology; Pain; Primary care; Rhinitis; Risk factors; Sinuses; Sinusitis; Streptococcus infections; Surgery; Malaysia
• EISSN: 1985-2274
• ISSN: 1985-2274; 1985-207X

[...]the current accepted terminology is rhinosinusitis (RS). Symptoms such as fever, facial pain, purulent nasal discharge and duration of symptoms have been used to differentiate bacterial from viral RS, as shown below. * Acute bacterial rhinosinusitis (ABRS) is suggested when there are at least three symptoms/ signs of: * discoloured discharge (with unilateral predominance) and purulent secretion in the nasal cavity * severe local pain (with unilateral predominance) * fever (>38°C) * elevated erythrocyte sedimentation rate/C-reactive protein * deterioration of symptoms and signs Risk factors Risk factors for ARS are: * active smoker * allergic rhinitis (AR) For CRS, the risk factors are: * smoker (a second-hand smoker has a higher risk of CRS with current and past exposure) * positive family history * asthma, especially in the presence of CRS with nasal polyps (CRSwNP) * allergies, chronic bronchitis and emphysema * ARS * chronic rhinitis * gastroesophageal reflux disease * sleep apnoea * adenotonsillitis There is no evidence for a causal correlation between sinonasal anatomical variations, in general, and the incidence of CRS. Referral * ARS Early referral (within one week) criteria are: * persistent symptoms despite optimal therapy, in particular * immunocompromised patients such as those with uncontrolled diabetes, end-stage renal failure or a human immunodeficiency virus (HIV) infection * frequent recurrence (≥4 episodes per year) * anatomical defects causing obstruction * suspected malignancy Urgent referral (within 24 hours) criteria are: * orbital complications - periorbital oedema/erythema - displaced globe - double vision - ophtalmoplegia/restricted eye movement - reduced visual acuity * severe frontal/retro-orbital headache * forehead swelling (subperiosteal abscess) * neurological manifestations, such as meningitis, altered consciousness or seizure * septicaemia * CRS Early referral (within one week) criteria are: * failed course of optimal medical therapy * >3 sinus infections/year * suspected fungal infections, granulomatous disease or malignancy Urgent referral (within 24 hours) criteria are: * severe pain or swelling of the sinus areas, in particular in immunocompromised patients, such as those with uncontrolled diabetes, end-stage renal failure or an HIV infection Summaries of the Management of ARS & CRS in Primary Care are shown in Algorithms 1 and 2.