xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

Clinical impression, cacosmia, and pain in the teeth are predictors of ABRS

Hauer 145 2014 2** Systematic review ABRS and ARS Fever, facial pain Cannot distinguish viral from bacterial based on fever or facial pain VanDen Broek 314 2014 2** Systematic review RS URI Symptom duration, purulent rhinorrhea Cannot distinguish viral from bacterial based on symptom Young 326 2003 2 RCT Amoxicillin-Clavulanate Placebo

duration or purulent rhinorrhea

Discolored drainage, facial pain, radiological maxillary sinusitis were associated with positive culture.

Fiberoptic endoscopy is valuable for diagnosis of ABRS

ESR, CRP, WBC None of the blood tests were sensitive indicators of ABRS

TABLE VII-4 Evidence for differentiating viral from bacterial ARS Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Purulence Correlation of radiographic findings or purulence with sinus culture Diagnosis based on radiographs or purulent drainage only has a 50% correlation with positive cultures Ebell 297 2019 2* Meta-analysis ABRS and ARS Correlation of clinical impression and diagnostic studies

History of purulent discharge and visible pus in nasal cavity were more predictive of antibiotic

improvement than radiography or labs

Good concordance for the culture sites makes them a viable diagnostic tool.

Symptoms, blood labs Elevated ESR and CRP were sensitive but not specific for positive bacterial cultures

facial pain, radiograph compared to NPx culture

endoscopy, radiography with ABRS diagnosis

Symptom improvement by diagnostic predictors

Concordance between culture locations

Discolored discharge,

Correlation of fiberoptic

Positive or negative maxillary sinus cultures

Positive or negative maxillary sinus cultures

Rhinosinusitis URI

Berger 328 2011 3 Prospective cohort ABRS noABRS

NPx Culture

MMCulture

Savolainen 325 1997 3 Validating cohort study

Lacroix 317 2002 2 Validating cohort study

Lee 327 2013 3 Validating cohort study

Hansen 323 2009 3 Validating cohort study

Smith 298 2014 1 Systematic Review Radiographic evidence

*Level of evidence was downgraded because of heterogeneity of studies included. These also included many studies with a high risk for bias. **Level of evidence was downgraded due to the small number of studies included.