DeMuri Gregory, Wald Ellen R
Associate Professor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Pediatr Rev. 2013 Oct;34(10):429-37; quiz 437. doi: 10.1542/pir.34-10-429.
On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.
基于强有力的研究证据，鼻窦炎的发病机制涉及三个关键因素：鼻窦开口阻塞、纤毛功能障碍以及鼻窦分泌物增厚。基于对中耳炎微生物学的研究，流感嗜血杆菌在鼻窦炎病因中发挥着越来越重要的作用，在某些地区超过了肺炎链球菌，并且在美国呼吸道分离株中流感嗜血杆菌产生β-内酰胺酶的情况正在增加。基于一些研究证据和共识，急性细菌性鼻窦炎的表现符合三种可预测模式中的一种：症状持续、严重且不断恶化。基于一些研究证据和共识，鼻窦炎的诊断应采用严格的临床标准。这种方法将筛选出最有可能从抗生素治疗中获益的患有上呼吸道感染症状的儿童。基于一些研究证据和共识，鼻窦炎诊断时通常不建议进行影像学检查。当怀疑有鼻窦炎并发症时，计算机断层扫描或磁共振成像可提供有用信息。基于一些研究证据和共识，阿莫西林-克拉维酸应被视为治疗鼻窦炎的一线药物。
