TAILIEUCHUNG - Canadian clinical practice guidelines for acute and chronic rhinosinusitis

The rationale for selecting three cardinal symptoms is based on their high sensitivity and their relatively high specificity for ABRS, especially when considering the time interval of persistence for 10 days or longer. 36-38 Purulent nasal drainage predicts presence of bacteria on antral aspi- ration when reported as purulent rhinorrhea by the patient, when manifest as postnasal drip or purulent discharge in the posterior pharynx, or when observed in the nasal cavity or near the sinus ostium. 39,40 Purulent rhinorrhea also predicts radiographic evidence of ABRS. 41,42 Facial or dental pain also predicts ABRS, 38,40 but the location correlates poorly with the specific sinuses involved. 43 Lastly, patient com- plaints of nasal obstruction correlate with objective mea- sures, such as rhinomanometry or nasal. | Desrosiers et al. Allergy Asthma Clinical Immunology 2011 7 2 http content 7 1 2 ALLERGY ASTHMA CLINICAL IMMUNOLOGY REVIEW Open Access Canadian clinical practice guidelines for acute and chronic rhinosinusitis A I S I Ch r r c I V r 1 c cs r I I A C sv kr 2D iil X IX T i-f-p 3 Ch A riz-ik-f-4AI LX S L I s 5 I r r t I I cs c Dcm I M C J6 Martin Desrosiers Gerald A Evans Paul K Keim Erin D Wright Alan Kaplan Jacques Bouchard 7 8 9 10 11 12 Anthony Ciavarella Patrick W Doyle Amin R Javer Eric S Leith Atreyi Mukherji R Robert Schellenberg Peter Small13 Ian J Witterick14 Abstract This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis ARS and chronic rhinosinusitis CRS to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis ABRS and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007 but these are either limited in their coverage of the subject of CRS do not follow an evidence-based strategy or omit relevant stakeholders in guidelines development and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS along with the development of appropriate therapeutic strategies have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection CRS is now recognized as having multiple distinct components eg infection inflammation which have led to changes in therapeutic approaches eg increased use of corticosteroids . The role of bacteria in the persistence of chronic infections and the roles of surgical and medical management are .

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