Otorhinolaryngologic Diseases

SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.

In the treatment of chronic rhinosinusitis, antibiotics are often given for 3 to 6 weeks, but the optimal regimen has not been established. Dubin and coworkers conducted a study to assess the effectiveness of a 3-week course. They found that for some patients, significant radiographic improvement occurs when antibiotics are given for more than 3 weeks.

LONDON -- As a quick screening tool, the ratio of a patient's white blood cell types differentiated acute purulent tonsillitis from infectious mononucleosis, researchers here reported.

A study conducted in France provides further evidence of how allergic rhinitis adversely affects quality of life. Léger and associates found that allergic rhinitis impairs all dimensions of sleep quality.

Many patients with postnasal drip syndrome, allergic rhinitis, or sinusitis use nasal saline solution erratically and only a few drops at a time. Be sure to tell patients that they must flush their nasal passages with a generous amount of saline solution at least 4 or 5 times a day to have an effect.

Among American children,acute otitis media(AOM) is the most commonbacterial infectiontreated with antibiotics.Rising rates of antibacterial resistancecoupled with the increasingcost of antibiotics have focused attentionon the need to prescribethese agents judiciously. Recently,the American Academy of Pediatricsissued recommendations on the diagnosisand management of uncomplicatedAOM in children aged 2months to 12 years.1 These guidelinesapply only to otherwise healthychildren who have no underlyingconditions that may alter the naturalcourse of AOM, such as cleft palate,Down syndrome, immunodeficiencies,or the presence of cochlear implants.Also excluded are childrenwho have recurrent AOM or AOMwith underlying chronic otitis mediawith effusion (OME). Highlights ofthe guidelines are presented here.

A 37-year-old man found unresponsiveat home with erratic respiration andurinary incontinence was brought tothe emergency department (ED). Accordingto his family, the patient hadbeen complaining of headaches, vertigo,and mild neck pain for 2 months.During that time, a CT scan of thesinuses revealed chronic sinusitis; thepatient had completed a course ofprednisone, naproxen, and meclizinewithout symptomatic improvement.The day before he was brought to theED, he had presented to a differenthospital with the same complaints andwas given a prescription for antibioticsfor a presumed sinus infection. He haddiet-controlled hypercholesterolemiaand did not smoke.

TURKU, Finland -- Most children with acute otitis media have infections caused by both bacteria and viruses, suggesting that antibiotics may not be enough to control the infections, researchers here have found.

UTRECHT, The Netherlands -- Reserve antibiotics for children younger than two years old with bilateral acute otitis media infections or for any child with otorrhea, researchers here recommended. For other children, watchful waiting seems justified

Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)