Sinus and Nasal Specialists of Louisiana, Baton Rouge, LA.
Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia.
Int Forum Allergy Rhinol. 2017 Jul;7(7):726-733. doi: 10.1002/alr.21925. Epub 2017 May 11.
Episodic or recurrent sinonasal symptoms are often suspected as "sinus" in origin. With normal sinus radiology between events, the diagnosis of recurrent acute rhinosinusitis (RecARS) is made. However, other conditions can produce episodic symptoms. In this study we analyze acutely performed computed tomography (CT) in a population with suspected or self-diagnosed "sinus" disease.
Patients referred to a tertiary clinic for suspected RecARS were assessed. Sinus changes were defined by CT (initial assessment) and during the acute event, by a semiurgent CT performed during the symptomatic episode. Mucosal thickening, ostiomeatal compromise, and severe septal deformity were recorded. Symptom profile was assessed during both time-points with the 22-item Sino-Nasal Outcome Test (SNOT-22).
Forty-eight patients (49.5 ± 14.7 years of age, 70.8% female) were assessed. At presentation, 75% were resolute in a diagnosis of "sinus." Baseline Lund-Mackay scores were <6 (median 0 [interquartile range 1]). Ostiomeatal compromise was 6.8% left and 4.5% right at baseline. Of the patients who returned for acute CT (n = 27), SNOT-22 and subdomains were similar to baseline. Septal deviation was similar (13.6% vs 15.3%). Acutely, ostiomeatal compromise was 0% left and 7.4% right (n = 2). Of these 2 patients with ostiomeatal compromise, 1 was diagnosed with RecARS (4%) and the other with triptan-responsive migraine, with incidental sinus changes. Final diagnosis was rhinitis (47%), headache/migraine (37%), and facial pain otherwise undefined (12.5%).
Patients with a history of "recurrent acute sinusitis" and normal CT scans between episodes rarely have abnormal CT findings during acute exacerbations of symptoms. Antibiotics and surgical intervention are often inappropriate in this population.
发作性或复发性鼻-鼻窦症状常被怀疑为“鼻窦”来源。在事件之间出现正常鼻窦放射学表现时，作出复发性急性鼻-鼻窦炎（RecARS）的诊断。然而，其他情况也可产生发作性症状。在本研究中，我们分析了怀疑或自我诊断为“鼻窦”疾病的人群中急性进行的计算机断层扫描（CT）。
评估了因疑似 RecARS 而转至三级诊所的患者。鼻窦变化通过 CT（初始评估）和在症状发作期间进行的半紧急 CT 来定义。记录了黏膜增厚、筛窦口阻塞和严重鼻中隔偏曲。在两次就诊时均使用 22 项鼻-鼻窦炎结局测试（SNOT-22）评估症状谱。
评估了 48 例患者（49.5±14.7 岁，70.8%为女性）。就诊时，75%的患者确诊为“鼻窦”。基线 Lund-Mackay 评分<6（中位数 0[四分位距 1]）。基线时左侧和右侧筛窦口阻塞分别为 6.8%和 4.5%。返回进行急性 CT 的 27 例患者中，SNOT-22 和子域与基线相似。鼻中隔偏曲也相似（13.6%比 15.3%）。急性时，左侧和右侧筛窦口阻塞分别为 0%和 7.4%（n=2）。在这 2 例筛窦口阻塞患者中，1 例被诊断为 RecARS（4%），另 1 例被诊断为曲坦类药物反应性偏头痛，伴有偶然的鼻窦改变。最终诊断为鼻炎（47%）、头痛/偏头痛（37%）和其他未明确的面部疼痛（12.5%）。
有“复发性急性鼻窦炎”病史且在发作之间的 CT 扫描正常的患者，在症状急性加重期间很少出现异常 CT 发现。在该人群中，抗生素和手术干预通常是不适当的。
