Classification, Diagnosis and Treatment of Sinusitis: Evidence‐Based Clinical Practice Guidelines
Abstract
OBJECTIVE: To provide evidence‐based recommendations for classification, diagnosis and treatment of acute, chronic and recurrent acute sinusitis in adults and children. DATA SOURCES: Review articles, textbooks, other published guidelines and recommendations of task force members. STUDY SELECTION: One hundred and seventy‐one papers addressing one or all of the objectives. DATA EXTRACTION: Relevant data were collated under each objective. DATA SYNTHESIS: Validity of diagnostic and treatment evidence was assessed by using the methodological recommendations of Sackett et al and the canadian Task Force on Periodic Health Examination, respectively. Where there was a paucity of data, consensus of task force members was reached. CONCLUSIONS: Sinusitis is classified as acute, chronic or recurrent acute disease according to duration and frequency of symptoms and response to therapy (expert opinion). Potential risk factors, concomitant diseases and complications are identified (limited evidence). Diagnosis is based on symptoms, history and physical examination. For adults, independentpredictors of acute sinusitis include maxillary toothache, coloured nasal discharge, poor response to nasal decongestants/antihistamines and mucopurulent nasal secretions (good evidence); for children, cough, nasal discharge and fever are common (good evidence). For chronic disease that persists despite adequate therapy and recurrent acutedisease, referral to a specialist for investigative measures (nasal…
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