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Ellen R Wald – One of the best experts on this subject based on the ideXlab platform.

  • decongestants antihistamines and nasal irrigation for Acute Sinusitis in children
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Nader Shaikh, Ellen R Wald
    Abstract:

    Background The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed Acute Sinusitis has not been systematically evaluated. Objectives To determine the efficacy of decongestants, antihistamines or nasal irrigation in improving symptoms of Acute Sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with Acute Sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic Sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors’ conclusions There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with Acute Sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with Acute Sinusitis.

  • Predicting response to antimicrobial therapy in children with Acute Sinusitis.
    The Journal of pediatrics, 2013
    Co-Authors: Nader Shaikh, Ellen R Wald, Jong H. Jeong, Marcia Kurs-lasky, A'delbert Bowen, Lynda L. Flom, Alejandro Hoberman
    Abstract:

    Objective To determine prognostic factors that independently predict response to antimicrobial therapy in children with Acute Sinusitis. Study design A total of 206 children meeting a priori clinical criteria for Acute Sinusitis who were prescribed antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8-12 days after treatment was initiated was followed with the use of a validated scale. We examined the univariate and multivariate association between factors present at the time of diagnosis (symptoms, signs, nasopharyngeal culture result, radiograph results) and time to resolution of symptoms. This study was conducted 8-10 years after the 7-valent pneumococcal conjugate vaccination was introduced but before introduction of the 13-valent pneumococcal conjugate vaccination. Results Children with proven nasopharyngeal colonization with Streptococcus pneupneumoniae improved more rapidly (6.5 vs 8.5 median days to symptom resolution) than those who were not colonized with S pneumoniae . Age and radiograph findings did not predict time to symptom resolution. Conclusions In children with Acute Sinusitis, proven nasopharyngeal colonization with S pneumoniae at presentation independently predicted time to symptom resolution. Future randomized, placebo-controlled trials could investigate the usefulness of testing for the presence of nasopharyngeal pathogens as a predictor of response to treatment.

  • signs and symptoms that differentiate Acute Sinusitis from viral upper respiratory tract infection
    Pediatric Infectious Disease Journal, 2013
    Co-Authors: Nader Shaikh, Alejandro Hoberman, Jong H. Jeong, A'delbert Bowen, Lynda L. Flom, Diana H Kearney, Kathleen D Colborn, Marcia Kurslasky, Mary Ann Haralam, Ellen R Wald
    Abstract:

    Objective Differentiating Acute bacterial Sinusitis from viral upper resprespiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with Acute Sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for Sinusitis but who nevertheless have a viral URI. Methods We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for Acute Sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for Sinusitis. We examined the utility of signs and symptoms in identifying children with URI. Results Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal versus abnormal radiographs. Conclusions Among children meeting current criteria for the diagnosis of Acute Sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected Sinusitis; their absence favors a diagnosis of URI.

Nader Shaikh – One of the best experts on this subject based on the ideXlab platform.

  • decongestants antihistamines and nasal irrigation for Acute Sinusitis in children
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Nader Shaikh, Ellen R Wald
    Abstract:

    Background The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed Acute Sinusitis has not been systematically evaluated. Objectives To determine the efficacy of decongestants, antihistamines or nasal irrigation in improving symptoms of Acute Sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with Acute Sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic Sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors’ conclusions There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with Acute Sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with Acute Sinusitis.

  • Predicting response to antimicrobial therapy in children with Acute Sinusitis.
    The Journal of pediatrics, 2013
    Co-Authors: Nader Shaikh, Ellen R Wald, Jong H. Jeong, Marcia Kurs-lasky, A'delbert Bowen, Lynda L. Flom, Alejandro Hoberman
    Abstract:

    Objective To determine prognostic factors that independently predict response to antimicrobial therapy in children with Acute Sinusitis. Study design A total of 206 children meeting a priori clinical criteria for Acute Sinusitis who were prescribed antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8-12 days after treatment was initiated was followed with the use of a validated scale. We examined the univariate and multivariate association between factors present at the time of diagnosis (symptoms, signs, nasopharyngeal culture result, radiograph results) and time to resolution of symptoms. This study was conducted 8-10 years after the 7-valent pneumococcal conjugate vaccination was introduced but before introduction of the 13-valent pneumococcal conjugate vaccination. Results Children with proven nasopharyngeal colonization with Streptococcus pneumoniae improved more rapidly (6.5 vs 8.5 median days to symptom resolution) than those who were not colonized with S pneumoniae . Age and radiograph findings did not predict time to symptom resolution. Conclusions In children with Acute Sinusitis, proven nasopharyngeal colonization with S pneumoniae at presentation independently predicted time to symptom resolution. Future randomized, placebo-controlled trials could investigate the usefulness of testing for the presence of nasopharyngeal pathogens as a predictor of response to treatment.

  • signs and symptoms that differentiate Acute Sinusitis from viral upper respiratory tract infection
    Pediatric Infectious Disease Journal, 2013
    Co-Authors: Nader Shaikh, Alejandro Hoberman, Jong H. Jeong, A'delbert Bowen, Lynda L. Flom, Diana H Kearney, Kathleen D Colborn, Marcia Kurslasky, Mary Ann Haralam, Ellen R Wald
    Abstract:

    Objective Differentiating Acute bacterial Sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with Acute Sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for Sinusitis but who nevertheless have a viral URI. Methods We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for Acute Sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for Sinusitis. We examined the utility of signs and symptoms in identifying children with URI. Results Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal versus abnormal radiographs. Conclusions Among children meeting current criteria for the diagnosis of Acute Sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected Sinusitis; their absence favors a diagnosis of URI.

John Yaphe – One of the best experts on this subject based on the ideXlab platform.

  • intranasal steroids for Acute Sinusitis
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Anca Zalmanovici Trestioreanu, John Yaphe
    Abstract:

    Background Acute Sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. Objectives We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of Acute Sinusitis in adults and children. Search methods We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies. Selection criteria Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with Acute Sinusitis. Acute Sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Data collection and analysis Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus. Main results No new trials were found for inclusion in this update. Four studies involving 1943 participants with Acute Sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS. Authors’ conclusions Current evidence is limited for Acute Sinusitis confirmed by radiology or nasal endoscopy but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

  • The Cochrane Library – Intranasal steroids for Acute Sinusitis.
    The Cochrane database of systematic reviews, 2013
    Co-Authors: Anca Zalmanovici Trestioreanu, John Yaphe
    Abstract:

    Background Acute Sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. Objectives We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of Acute Sinusitis in adults and children. Search methods We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies. Selection criteria Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with Acute Sinusitis. Acute Sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Data collection and analysis Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus. Main results No new trials were found for inclusion in this update. Four studies involving 1943 participants with Acute Sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS. Authors’ conclusions Current evidence is limited for Acute Sinusitis confirmed by radiology or nasal endoscopy but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

  • Intranasal steroids for Acute Sinusitis.
    The Cochrane database of systematic reviews, 2009
    Co-Authors: Anca Zalmanovici, John Yaphe
    Abstract:

    Acute Sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of Acute Sinusitis. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2008, issue 4) which contains the Acute Respiratory Infections Group’s Specialized Register, MEDLINE (January 1966 to October 2008), EMBASE (1990 to October 2008) and bibliographies of included studies. Randomized controlled trials (RCTs) were considered eligible if they compared INCS treatment to placebo treatment of a control group for Acute Sinusitis; Acute Sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Two review authors independently extracted the data, assessed trial quality and resolved discrepancies by consensus. Four studies with 1943 participants met the inclusion criteria. The trials were well designed, double-blind, placebo controlled in which the included participants had Acute Sinusitis. The treatment assigned was INCS versus control treatment for 15 or 21 days. The rates of loss to follow up in the studies were 7%, 11%, 41% and 10%. When the results from the three trials included in the meta-analysis were combined, participants receiving INCS were more likely to have resolution or improvement of symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% CI 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement or complete relief of symptoms: for mometasone furoate (MFNS) 400 mcg versus 200 mcg, (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rate for the two treatment groups and for groups receiving higher doses of INCS. For Acute Sinusitis confirmed by radiology or nasal endoscopy, current evidence is limited, but supports the use of INCS as a monotherapy or as an adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events when prescribing therapy.

Sukgi S Choi – One of the best experts on this subject based on the ideXlab platform.

  • orbital complications of Acute Sinusitis changes in the post pneumococcal vaccine era
    Archives of Otolaryngology-head & Neck Surgery, 2013
    Co-Authors: Maria T Pena, Diego Preciado, Michael I Orestes, Sukgi S Choi
    Abstract:

    Importance The widespread use of the 7-valent pneumococcal conjconjugate vaccine (PVC7), developed to combat invasive Streptococcus pneupneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from Acute Sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to Acute Sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. Objective To determine if the characteristics of orbital complications from Acute Sinusitis in children have changed in the post-PCV7 era. Design Review of clinical data. Setting Tertiary care children’s hospital. Participants Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Main Outcome Measures Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. Results A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans –positive sinus or blood cultures were observed (22.4% vs 0% [P  Conclusions and Relevance Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in Acute Sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to Acute Sinusitis.

  • Orbital Complications of Acute Sinusitis: Changes in the Post–Pneumococcal Vaccine Era
    JAMA otolaryngology– head & neck surgery, 2013
    Co-Authors: Maria T Pena, Diego Preciado, Michael I Orestes, Sukgi S Choi
    Abstract:

    Importance The widespread use of the 7-valent pneumococcal conjconjugate vaccine (PVC7), developed to combat invasive Streptococcus pneupneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from Acute Sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to Acute Sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. Objective To determine if the characteristics of orbital complications from Acute Sinusitis in children have changed in the post-PCV7 era. Design Review of clinical data. Setting Tertiary care children’s hospital. Participants Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Main Outcome Measures Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. Results A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans –positive sinus or blood cultures were observed (22.4% vs 0% [P  Conclusions and Relevance Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in Acute Sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to Acute Sinusitis.

Maria T Pena – One of the best experts on this subject based on the ideXlab platform.

  • orbital complications of Acute Sinusitis changes in the post pneumococcal vaccine era
    Archives of Otolaryngology-head & Neck Surgery, 2013
    Co-Authors: Maria T Pena, Diego Preciado, Michael I Orestes, Sukgi S Choi
    Abstract:

    Importance The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from Acute Sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to Acute Sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. Objective To determine if the characteristics of orbital complications from Acute Sinusitis in children have changed in the post-PCV7 era. Design Review of clinical data. Setting Tertiary care children’s hospital. Participants Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Main Outcome Measures Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. Results A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans –positive sinus or blood cultures were observed (22.4% vs 0% [P  Conclusions and Relevance Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in Acute Sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to Acute Sinusitis.

  • Orbital Complications of Acute Sinusitis: Changes in the Post–Pneumococcal Vaccine Era
    JAMA otolaryngology– head & neck surgery, 2013
    Co-Authors: Maria T Pena, Diego Preciado, Michael I Orestes, Sukgi S Choi
    Abstract:

    Importance The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from Acute Sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to Acute Sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. Objective To determine if the characteristics of orbital complications from Acute Sinusitis in children have changed in the post-PCV7 era. Design Review of clinical data. Setting Tertiary care children’s hospital. Participants Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Main Outcome Measures Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. Results A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans –positive sinus or blood cultures were observed (22.4% vs 0% [P  Conclusions and Relevance Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in Acute Sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to Acute Sinusitis.