国外鼻窦炎精彩.pptVIP

* This sinus CT scan was taken one month after treatment of the patient in the previous slide with antibiotics for four weeks. The sinuses are now clear, and the OMU are now patent bilaterally. * A number of local and systemic factors predispose to the development of sinusitis6. The factors are summarized in this slide. Basically, any local condition that interferes with normal sinus drainage predisposes to the development of infection. * The physician must also be aware that certain systemic disorders may present with recurrent sinusitis. The most common form of hypogammaglobulinemia is IgA deficiency. * The important complications of sinusitis are listed on this slide. The specific complication is often linked to infection of a particular sinus. In particular, S. aureus sphenoiditis is associated with cavernous sinus thrombosis. 1/10,000 cases * Literature is unsatisfactory No db randomized study using aspirates pre and post * Of 2058 articles ( 1861 were rejected definitely not meeting inclusion criteria simply on the basis of title or abstract) Abx versus controls, abx comparison Outcome: global change in clinical status Secondary outcome measures: bacteriological cure, radiographic improvement, relapse rate (7.7%), drop out due to adverse effects * Jacobs et. al. Susceptibiities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. Surveillance study. Antimicrob Agents Chemother 1999;43:190-8. Jacobs et al. The Alexander Project 1998-2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J. Antimicrob Chemother 2003;52:229-46. Jones R. SENTRY Surveilllance Program-US isolates; 2003 * Acute uncomplicated sinusitis * No difference in outcome Difference in cost not due to other charges * Sinus Allergy Health Partnership. Otolaryngol HeadN Surg 2004;130:1 * Dx based on symptoms is common but unreliab