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ESSENTIALS OF DIAGNOSIS
The vast majority of cases of acute rhinosinusitis are self-limiting viral events.
Chronic rhinosinusitis is an inflammatory disease whose causes are often multifactorial.
In chronic rhinosinusitis, nasal endoscopy and/or computed tomography (CT) scan may be necessary to make the diagnosis if symptoms do not correlate well with findings.
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General Considerations
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Rhinosinusitis is one of the most commonly diagnosed medical conditions in the United States, affecting an estimated 12% of the adult population annually. Overall health care costs are significant, estimated to be over $6.9 to $9.9 billion 2014 USD per year. Acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) together account for more primary care visits with antibiotic prescriptions than any other conditions from 2006 to 2010.
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Smith
KA, Orlandi
RR, Rudmik
L. Cost of adult chronic rhinosinusitis: a systematic review. Laryngoscope. 2015 Jul;125(7):1547–1556. (This systematic review summarizes current data on the costs associated with treating chronic rhinosinusitis).
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Smith
SS, Evans
CT, Tan
BK, Chandra
RK, Smith
SB, Kern
RC. National burden of antibiotic use for adult rhinosinusitis. J Allergy Clin Immunol. 2013 Nov 1;132(5):1230–1232.
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Rhinosinusitis: Classification and Diagnosis
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Rhinosinusitis is broadly defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. The term rhinosinusitis is used because sinusitis is almost always accompanied by inflammation of the contiguous nasal mucosa. There have been a number of iterations of the actual definition, which are described in this section. The Rhinosinusitis Task Force in 1997 classified rhinosinusitis based on both symptom duration and by history. In 2003, another task force that included the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) proposed revised guidelines that required physical exam findings for the diagnosis of CRS. Findings on nasal endoscopy or anterior rhinoscopy should include 1 or more of the following: purulent drainage, polyps, polypoid changes in the mucosa, and edema or erythema of the middle meatus. These guidelines also suggest that CT scans can be helpful to confirm the diagnosis of symptomatic patients with equivocal physical exam findings. In 2004, a multidisciplinary panel further classified CRS as CRS with nasal polyps, CRS without nasal polyps, and allergic fungal rhinosinusitis (AFS) to better guide clinical research and patient care.
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Acute rhinosinusitis: Duration ≤ 4 weeks
Subacute rhinosinusitis: Duration 4 to 12 weeks
Chronic rhinosinusitis: Duration ≥ 12 weeks
Recurrent acute rhinosinusitis: Four or more episodes of acute rhinosinusitis per year, with each episode lasting ≥ 7 to 10 days, with symptom resolution between episodes
Acute exacerbations of CRS are a sudden worsening of CRS with a return to baseline after treatment.
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Most recently in 2007 and 2015, new clinical practice guidelines were developed to improve and update the diagnosis of rhinosinusitis. CRS is now defined as 12 weeks or longer of 2 or more of the following symptoms:
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