Definition, pathophysiology and epidemiology of acute sinusitis
Definition of the disorder
Acute sinusitis can be defined as an inflammation of the sinuses characterized by symptoms lasting up to four (4) weeks (Mandal, Patel, & Ferguson, 2012). It can be prompted by some inciting factors such as bacteria, fungi, infections, allergens or environmental irritants. A viral etiology related to the ‘common’ cold is the most common cause of acute sinusitis.
Pathophysiology
Numerous factors cause the development of acute sinusitis. In most cases, a viral respiratory infection occurs before the bacterial sinusitis, which subsequently results in the inflammation of the sinuses and blocking of the ostiomeatal complex (Wald et al., 2013). Consequently, the drainage and ventilation of the frontal ethmoid, maxillary, and anterior sinuses are both compromised. When this happens, both the oxygen content and pH level reduce, making the cilia less functional, damaging the mucosa, and increasing the risk of the micro-environment becoming infected. Roughly 0.5 percent to 2 percent of viral sinusitis lead to bacterial infections. Distinguishing between viral and bacterial sinusitis can be challenging; typically, viral sinusitis can end within 1 week to 10 days while bacterial sinusitis continues to be persistent.
Epidemiology
According to Meltzer and Hamilos (2011), rhinosinusitis affects an estimated 1 in every 7 adults living in the US, and its impact on productivity, quality of life, and finances is significant. Between 6 percent and 7 percent of children in need of care for respiratory symptoms have a health problem consistent with acute sinusitis (Wald et al., 2013). Acute sinusitis is a frequently encountered illness affecting up to 20 million people annually and inflicts a weighty health care burden with regards to causing patient distress as well as leading to huge financial expenditures estimated at about US$ 3 billion in the US alone (Mandal, Patel, & Ferguson, 2012).
Protocol for diagnosis, management, and follow-up care
Diagnosis
Even though sinus aspirates are viewed as the gold standard for diagnosis, it is not often recommended for use in a primary clinical setting because it is an invasive procedure. Hence, clinicians have to rely on clinical findings and physical examination to do an initial evaluation of the illness; generally, acute sinusitis can be diagnosed without using special imaging techniques or any other technical assessments. One approach to the diagnosis should comprise an examination of the color, the character of nasal secretions, edema, structure of the nasal septum, and the presence of polyps. Pus-filled release from the middle meatus is primarily suggestive of bacterial sinusitis (Wald et al., 2013). Checking for tenderness of both the frontal and maxillary sinuses can be predictive of acute sinusitis as well. Transillumination of the sinuses, which is limited to the maxillary and frontal sinuses, can also work as an additional diagnostic test since other sinuses are extremely difficult to examine. When examining the maxillary sinus, for example, a light source is positioned over the infra-orbital rim so that the light transmission can be observed.
Management protocol
For initial treatment of acute sinusitis, most clinicians recommend the use of antibiotic therapy. Antibiotic therapy can be defined as the initial treatment of acute sinusitis using antibiotics, with the resolve to begin such treatment earliest after the encounter. Additional outpatient observation is also a typical treatment plan for acute sinusitis. Additional outpatient observation can be defined as the initial management of acute sinusitis, which is limited to constant 3-day observation with the option of commencing antibiotic therapy if either the patient does not show signs of clinical improvement within many days of diagnosis or if there the patient’s clinical condition deteriorates at any given time.
Follow-up care
Following up on the initial management of acute sinusitis creates an opportunity for integrated decision-making with families. Issues that might affect this decision comprise quality of life, recent antibiotic use, cost of antibiotics, symptom severity, ease of administration, previous experience with acute bacterial sinusitis, or caregiver concerns about development of complications. Most importantly, the values and preferences of the caregiver should be given the utmost priority.
Impact of culture on patient care
Hispanic group comprises of the fastest growing minority group in America and in terms health they are better off than other ethnic groups. However, most patients suffering from acute sinusitis are Hispanic comparing with other ethnic groups. Therefore, there is a high prevalence for them to get this disease. This is most probably because of their lifestyle. For example, it is noted that many of them often take too delay in taking their members to hospital until their conditions become worse and immediate medical attention is required. There are many possible reasons for this, some of them include: adverse poverty in the Hispanic society and lack of health insurance because many Hispanic are known for their immigrant status. These and other factors in the Hispanic society make them miss out on appropriate health care to tackle acute sinusitis. Furthermore, some cultural practices also discourages appropriate health care, for example, the expectation that a person should tolerate pain without complaint.
Conclusion
In conclusion, appropriate health care should be given to patients with acute sinusitis. The common practice for most clinicians is to use sinus puncture as the standard criterion or methodology for confirming bacterial pathogens present in the maxillary sinuses (Mandal, Patel, & Ferguson, 2012). For that reason, sinus puncture has most applicability in the cotext of clinical care for patients with acute sinusitis. However, some clinical conditions may require sinus puncture to acquire diagnostic cultures.
References
Mandal, R., Patel, N., & Ferguson, B. J. (2012). Role of antibiotics in sinusitis. Wolters Kluwer Health, 25(2), 183-192.
Meltzer, E. O., & Hamilos, D. L. (2011). Rhinosinusitis diagnosis and management for the clinician: A Synopsis of recent consensus guidelines. Mayo Clinic Proceedings, 86(5), 427-443.
Wald, et al. (2013). Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. American Academy of Pediatrics, 132(1), 262-80.
