THE JOURNAL OF

ALLERGY AND

CLINICAL VOLUME

IMMUNOLOGY

90

Introduction

NUMBER 3, PART 2

and definition

of sinusitis

Gail G. Shapiro, MD, and Gary S. Rachelefsky, MD Seattle, Wash., and Los Angeles, Calif.

We entered the world of clinical researchand clinical practice at the same time but in two different locations. Within a short time we became intrigued by patients who had chronic respiratory symptomsthat did not fall into the limited diagnostic pigeonhole diagnosesof the early 1970s. Soon we were reporting our experiencesand agreeing that patients who were referred for evaluation of allergies commonly had sinus disease. Over the years our interest in sinusitis has grown as has the number of scientists and practitioners who shareour desire to understandand better managethis complex problem. This symposium was an opportunity to assemble many of the most knowledgeable researchersand clinicians devoting time to the study of sinus diseasetoday. We expect their contributions to form a body of knowledge that will appeal to the sophisticatedclinician whoseexpertisesurpasseswhat one finds in a textbook. The topics addressedinclude anatomy of the paranasalsinuses,physiologic defense mechanisms, diagnostic measures,medical management, surgical management,and the relationship between sinusitis and asthma and sinusitis and cystic fibrosis. We hope that these symposium proceedings will serve multiple purposes:to provide a knowledge basefor the interestedreader, to allow cross-fertilization of ideas among contributors, and to plant the seedsfor further researchendeavors. DEFINITION OF SINUSITIS One of the most formidable tasks of the symposium was to arrive at a consensuson the definitions of acute l/O/38483

TABLE I. Clinical

diagnosis

of sinusitis

Signs and symptoms Major criteria Purulent nasal discharge Purulent pharyngeal drainage Cough Minor criteria *Periorbital edema tHeadache tFacial pain PTooth pain Earache Sore throat Foul breath Increased wheeze Fever Diagnostic tests Major criteria Waters’ radiograph with opacification, air fluid level, or thickened mucosa filling ~50% of antrum Coronal CT scan with thickening of mucosa or opacification of sinus Minor criteria Nasal cytologic study (smear) with neurophils and bacteremia Ultrasound studies Probable sinusitis Signs and symptoms: 2 major criteria or 1 major and ~2 minor criteria Diagnostic tests: 1 major = confirmatory, 1 minor = supportive CT, Computerized tomographic. *More c~mrn~nin children. ?More common in adults.

417

418

Shapiro

and Rachelefsky

and chronic sinusitis. There is general agreement that sinusitis can be defined as inflammation of the paranasal sinus mucosa. Acute sinusitis can be defined by certain major and minor criteria that exist for longer than the typical viral upper respiratory tract infection, greater than 7 days. Table I groups these criteria by signs and symptoms and diagnostic tests. The presence of two major criteria or one major and two or more minor criteria for more than 7 days is highly likely to signify acute sinus disease, which is usually bacterial. If the signs and symptoms fulfill these criteria, the presence of one positive major diagnostic test is confirmatory, whereas the minor tests may be considered supportive. Another symptom, acute onset of fever with purulent rhinorrhea, is also considered highly likely to indicate acute bacterial sinusitis. The symposium participants agreed that certain diagnostic measures could provide valuable confirmatory information. Nasal cytologic studies showing a predominance of neutrophils could be helpful in this

regard. Waters’ radiographs showing significant membrane thickening, air fluid level, or antral opacification may also help establish a diagnosis. There was a consensus, however, that imaging studies were not universally necessary. Computerized tomographic scans were recommended as the imaging modality of choice to ascertain the extent of disease in patients who have chronic or recurrent disease, particulnrly hefore surgery. Chronic sinusitis was generally agreed to refer to disease that lasted more than 3 months. which manifested as long-term symptoms with or without an ongoing need for antibiotic therapy. Thus chronic sinusitis might occur on a noninfectious basis. The term “subacute” was used for the gray area between disease lasting less than 1 month (acute) and that lasting more than 3 months (chronic). The articles that follow present a Large body of information that includes new research on sinus disease, its diagnosis and treatment, and an assortment of difficult questions that remain to be answered.

Introduction and definition of sinusitis.

THE JOURNAL OF ALLERGY AND CLINICAL VOLUME IMMUNOLOGY 90 Introduction NUMBER 3, PART 2 and definition of sinusitis Gail G. Shapiro, MD, and G...
136KB Sizes 0 Downloads 0 Views