Pearlman Aaron N, Conley David B
Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL 60611, USA.
Curr Opin Otolaryngol Head Neck Surg. 2008 Jun;16(3):226-30. doi: 10.1097/MOO.0b013e3282fdcc9a.
Rhinosinusitis is one of the most common medical complaints, affecting nearly 31 million US citizens annually. Multiple medical professionals including emergency medicine, internal medicine, allergy, and otolaryngology treat rhinosinusitis, resulting in high-practice variability. This review will discuss recommendations of the 2007 American Academy of Otolaryngology - Head and Neck Surgery's multispecialty panel on evidence based clinical practice guidelines for diagnosis and treatment of rhinosinusitis.
The task force for recommendations defines rhinosinusitis as follows: acute bacterial, viral, chronic, or recurrent acute rhinosinusitis. For acute rhinosinusitis three symptoms are required: purulent nasal discharge with nasal obstruction and/or facial pain-pressure-fullness lasting between 10 days and 4 weeks. For viral rhinosinusitis, imaging is not recommended and treatment is symptomatic. For acute bacterial rhinosinusitis in an otherwise healthy patient, symptomatic relief is recommended including pain control. Amoxicillin is the first-line antibiotic of choice if needed. Radiographic imaging should be considered if an infectious complication is suspected. Chronic rhinosinusitis is likely when symptoms persist for greater than 12 weeks, with computed tomography being the gold standard for diagnostic testing. Nasal endoscopy and allergy/immune testing are also considered.
Accurate diagnosis of rhinosinusitis with recommended treatments should standardize management. However, these recommendations are guidelines and the clinician's judgment is highly important.
鼻窦炎是最常见的医疗问题之一，每年影响近3100万美国公民。包括急诊医学、内科、过敏科和耳鼻喉科在内的多个医学专业都治疗鼻窦炎，导致实践差异很大。本综述将讨论2007年美国耳鼻咽喉头颈外科学会多专业小组关于鼻窦炎诊断和治疗的循证临床实践指南的建议。
建议工作组将鼻窦炎定义如下：急性细菌性、病毒性、慢性或复发性急性鼻窦炎。对于急性鼻窦炎，需要三种症状：脓性鼻分泌物伴鼻塞和/或面部疼痛-压迫-胀满感持续10天至4周。对于病毒性鼻窦炎，不建议进行影像学检查，治疗以对症治疗为主。对于其他方面健康的急性细菌性鼻窦炎患者，建议进行对症治疗，包括控制疼痛。如有需要，阿莫西林是一线抗生素的首选。如果怀疑有感染性并发症，应考虑进行影像学检查。当症状持续超过12周时，可能为慢性鼻窦炎，计算机断层扫描是诊断测试的金标准。鼻内镜检查和过敏/免疫测试也可考虑。
采用推荐的治疗方法对鼻窦炎进行准确诊断应能使治疗标准化。然而，这些建议只是指南，临床医生的判断非常重要。
