eMedicine Specialties > Infectious Diseases > HEENT Infections

Sinusitis, Chronic: Follow-up

Author: Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Coauthor(s): Himal Bajracharya, MBBS, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Kansas University Medical Center; Daniel Hinthorn, MD, Director, Division of Infectious Diseases, Professor, Departments of Internal Medicine, Pediatrics and Family Medicine, University of Kansas
Contributor Information and Disclosures

Updated: Jun 17, 2009

Follow-up

Further Inpatient Care

  • Inpatient treatment of chronic sinusitis is indicated for patients with orbital and intracranial complications (see Complications).
  • Immunosuppressed patients and pediatric patients with chronic sinusitis may need inpatient care, depending on the severity of the disease.

Further Outpatient Care

  • Continued outpatient medical treatment with nasal decongestants and topical steroids is important even after surgical treatment.

Deterrence/Prevention

  • Certain conditions predispose to chronic sinusitis (see Causes). Environmental factors and/or allergic factors may predispose some individuals to chronic sinusitis. In these patients, the following preventive measures may be helpful:
    • Reduce exposure to dust, molds, cigarette smoke, and other environmental chemical irritants.
    • Environmental control, antihistamines, cromolyn, topical steroids, or immunotherapy may reduce recurrences and symptoms of allergic rhinitis.

Complications

Prognosis

  • Early and aggressive medical treatment for chronic sinusitis typically results in satisfactory outcomes.
  • FESS restores sinus health with complete or moderate relief of symptoms in 80-90% of patients with recurrent or medically unresponsive chronic sinusitis.

Miscellaneous

Medicolegal Pitfalls

  • Nasal swab culture does not correlate with sinus culture results. The role and type of microbes in the pathogenesis of chronic sinusitis is controversial.
  • Always consider serious underlying conditions, such as tumors and immunodeficiency states, in the workup.
  • Fungal sinusitis can be devastating in immunosuppressed patients and, rarely, in immunocompetent patients.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, to the development and writing of this article.



More on Sinusitis, Chronic

Overview: Sinusitis, Chronic
Differential Diagnoses & Workup: Sinusitis, Chronic
Treatment & Medication: Sinusitis, Chronic
Follow-up: Sinusitis, Chronic
References
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References

  1. Gwaltney JM Jr, Phillips CD, Miller RD, et al. Computed tomographic study of the common cold. N Engl J Med. Jan 6 1994;330(1):25-30. [Medline].

  2. Biel MA, Brown CA, Levinson RM, et al. Evaluation of the microbiology of chronic maxillary sinusitis. Ann Otol Rhinol Laryngol. Nov 1998;107(11 Pt 1):942-5. [Medline].

  3. Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am. Jun 2007;21(2):427-48, vii. [Medline].

  4. United States Food and Drug Administration. Zicam cold remedy nasal products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Saws, Kids Size). MedWatch Public Health Advisory. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm. Accessed June 16, 2009.

  5. Cunha BA. Antibiotic Essentials. 7th Ed. Royal Oak, MI: Physicans Press; 2008.

  6. Brook I. Bacteriology of chronic sinusitis and acute exacerbation of chronic sinusitis. Arch Otolaryngol Head Neck Surg. Oct 2006;132(10):1099-101. [Medline].

  7. Brook I. Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg. Sep 2006;135(3):349-55. [Medline].

  8. Brook I, Frazier EH, Foote PA. Microbiology of the transition from acute to chronic maxillary sinusitis. J Med Microbiol. Nov 1996;45(5):372-5. [Medline].

  9. Brook I, Yocum P. Immune response to Fusobacterium nucleatum and Prevotella intermedia in patients with chronic maxillary sinusitis. Ann Otol Rhinol Laryngol. Mar 1999;108(3):293-5. [Medline].

  10. Evans KL. Recognition and management of sinusitis. Drugs. Jul 1998;56(1):59-71. [Medline].

  11. Finegold SM, Flynn MJ, Rose FV, et al. Bacteriologic findings associated with chronic bacterial maxillary sinusitis in adults. Clin Infect Dis. Aug 15 2002;35(4):428-33. [Medline].

  12. Hafidh M, Harney M, Kane R, et al. The role of fungi in the etiology of chronic rhinosinusitis: a prospective study. Auris Nasus Larynx. Jun 2007;34(2):185-9. [Medline].

  13. Hinthorn D, Schwartz J. Efficacy and safety of cefixime and cefaclor in adults with purulent maxillary sinusitis. Postgrad Med. May 1998;58-62.

  14. Johnson JT, Ferguson BJ. Infection/paranasal sinus. Otolaryngol Head Neck Surg. 1998;2:1107-1134.

  15. Jyonouchi H, Sun S, Kennedy CA, et al. Localized sinus inflammation in a rabbit sinusitis model induced by Bacteroides fragilis is accompanied by rigorous immune responses. Otolaryngol Head Neck Surg. Jun 1999;120(6):869-75. [Medline].

  16. Lockey RF. Management of chronic sinusitis. Hosp Pract (Off Ed). Mar 15 1996;31(3):141-6,149-5. [Medline].

  17. Lund VJ. Surgical outcomes in chronic rhinosinusitis and nasal polyposis. Rhinology. Jun 2006;44(2):97. [Medline].

  18. Lusk R. Pediatric chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. Dec 2006;14(6):393-6. [Medline].

  19. Nord CE. The role of anaerobic bacteria in recurrent episodes of sinusitis and tonsillitis. Clin Infect Dis. Jun 1995;20(6):1512-24. [Medline].

  20. Slavin RG. Nasal polyps and sinusitis. JAMA. Dec 10 1997;278(22):1849-54. [Medline].

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Further Reading

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Keywords

chronic sinusitis, acute sinusitis, sinus infection, paranasal sinus, postnasal drip, facial pain, hyposmia, rhinitis, fungal sinusitis, cystic fibrosis, CF, asthma, nasal polyps, allergy, allergies, gastroesophageal reflux disease, GERD, brain abscess, meningitis, Streptococcus pneumoniae, S pneumoniae, Haemophilus influenzae, H influenzae, Moraxella catarrhalis, M catarrhalis, functional endoscopic sinus surgery, FESS

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Contributor Information and Disclosures

Author

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Coauthor(s)

Himal Bajracharya, MBBS, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Kansas University Medical Center
Himal Bajracharya, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Daniel Hinthorn, MD, Director, Division of Infectious Diseases, Professor, Departments of Internal Medicine, Pediatrics and Family Medicine, University of Kansas
Daniel Hinthorn, MD is a member of the following medical societies: American Academy of Family Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Kenneth C Earhart, MD, Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3
Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gordon L Woods, MD, Consulting Staff, Department of Internal Medicine, University Medical Center
Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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