A 48-Year-Old Man With Recurrent Sinusitis

Abstract

A 48-YEAR-OLD BUSINESSMAN PLAGUED by recurrent sinusitis for the last 21 years. Frequent infections interfere with his quality of life. He resides near Boston and is covered by commercial insurance.Mr S first experienced allergies and sinus infections when he moved to Oregon 21 years ago. After monthly episodes of sinusitis for more than a year, he underwent septoplasty, cauterization, and creation of "surgical windows" for improved drainage. He remained free of sinus infections for 1 year. Mr S then noted a pattern of sinus infections starting in the fall and lasting through the early spring. This coincided with his seasonal allergies, and he has received 4 series of allergy shots.Mr S describes a typical episode as clogged ears and postnasal drip causing hoarseness, followed by facial pain and warmth, yellow nasal discharge, and general malaise and fatigue. He cannot exercise during an episode and finds working and caring for his children especially difficult. His work requires him to travel; flying on airplanes with sinusitis is remarkably uncomfortable and once left him with vertigo for several weeks.Mr S reports using the following antibiotics for 5-to 30day courses: amoxicillin, sulfamethoxazole-trimethoprim, erythromycin, cefprozil, and azithromycin. He notes that antibiotics do not seem to work as fast as they used to.His past medical history is significant for hernia repair, seasonal allergies, vasectomy, and exertional asthma. His current medications include mometasone furoate nasal spray, 2 sprays daily; cetirizine hydrochloride, 10 mg/d; guaifenesinpseudoephedrine hydrochloride (600 mg and 120 mg, respectively), 1.5 tablets daily; montelukast sodium, 10 mg/d; and pirbuterol acetate inhaler as needed. Mr S is allergic to aspirin and all nonsteroidal anti-inflammatory drugs (NSAIDs).On physical examination, Mr S appears healthy, with normal vital signs, unremarkable head and neck examination, and clear lungs. Results of routine laboratory tests are all within normal limits. Computed tomographic (CT) scan of the sinuses from October 1999 shows no evidence of sinus thickening or disease.Mr S recently saw an otolaryngologist and is considering the pros and cons of endoscopic sinus surgery. He has sinusitis about 8 times per year. Mr S expresses concern about developing resistant bacteria and running out of effective antibiotics. He recalls a difficult recovery from his sinus surgery of 20 years ago and wonders if recovery now would be easier. He would like to know what his chances for shortand long-term success would be with surgery and how his surgeon would make that determination. MR S: HIS UNDERSTANDINGS AND PERCEPTIONS

Long-Term Quality of Life Measures after Functional Endoscopic Sinus Surgery

“…C hronic rhinosinusitis (CRS) is a common medical complaint, affecting over 33 million Americans and resulting in Ͼ25 million outpatient visits annually. [1][2][3] An often debilitating disease, CRS has an approximated societal cost of six billion dollars annually. 4 Currently, there exists a growing body of literature on the objective and symptom-specific efficacy of both medical and surgical interventions for CRS patients.…”

The Role of Bone in Chronic Rhinosinusitis

“… 5 Although the relative importance of the multiple etiological factors has not been clearly delineated, a general classification of risks includes environmental, systemic, and host issues. 4 When infectious agents are identified or cultured from the sinus mucosa in chronic inflammation, whether these organisms are a primary factor in the origin of the disease or represent secondary contamination as a result of other causes of inflammation and reduced mucociliary clearance is unclear. Thus, the extent to which chronic sinusitis represents a truly infectious problem, as opposed to a nonspecific inflammatory response, remains uncertain.…”

“… 1 This disease affects approximately 30 million Americans, significantly affects quality of life, and accounts for more than 25 million physician outpatient visits annually. 2–4 The multiple etiological factors and co‐morbid diseases associated with CRS (asthma, allergies, rhinitis) has made understanding the pathogenesis of this disease a continuing challenge. 5 Although the relative importance of the multiple etiological factors has not been clearly delineated, a general classification of risks includes environmental, systemic, and host issues.…”

The Internist's Literature on Chronic Rhinosinusitis: An Evaluation of the Amount and Quality of Published Information

“…19 In only one article were all fi ve core topics mentioned, and that was a case report on PubMed without an abstract. 20 Four studies were primarily devoted to CRS; the number of core information topics mentioned in each study ranged from zero to three. [21][22][23][24] Four letters to the editor primarily concerned CRS, but none of the authors mentioned any core information.…”