A systematic biomedical literature review was conducted in April
2005. The search was limited to English language articles and human
subjects, and included PubMed, the Cochrane Database, and the National
Guideline Clearinghouse. The current consensus documents for otitis
media with effusion, and for diagnosis and management of acute otitis
media can be found at the American Academy of Pediatrics website:
http://www.aap.org. Acute rhinosinusitis
consensus statements can be found at the National Guideline Clearinghouse
Sinusitis and otitis media (OM) are two of the most common presenting
conditions in primary care practice. They are frequent causes of
missed school and work days, and they cost the United States health
care system billions of dollars in office visits, surgeries, and
medications. They have a profound impact on quality of life, work
productivity, and school performance.1–4
Caring for patients with sinusitis and OM has changed dramatically
in the past few years. The vast body of literature on sinusitis
and OM suffers from widely divergent opinions regarding pathophysiology,
diagnosis, and treatment. As a result of poor standardization of
definitions, measures of severity, and improper clinical research
design, frequently cited studies often directly contradict each
other. Further, inappropriate antibiotic use leading to rising bacterial
resistance to antimicrobials and growing health care costs are compelling
trends that are impacting treatment approaches to these common illnesses.
For these reasons, recent evidence-based reference guidelines, systematic
reviews, and multidisciplinary consensus statements have been invaluable
in providing guidance to clinicians.
The upper airway is a complex system with numerous functions.
It includes the nose, the sinuses and pharyngeal structures, the
eustachian tubes, and the outer, middle, and inner ears (Fig. 38-1). The
paranasal sinuses, consisting of the maxillary, ethmoidal, sphenoidal,
and frontal sinuses are connected to the nasal passage and ultimately
the pharyngeal structures. These sinuses are thought to aid the
nose in providing heat and humidification to inhaled air, while
also decreasing the weight of the bony skull and increasing resonance
for speech. The osteomeatal complex, a narrow orifice connecting
the maxillary sinuses to the nasal passage, is a critical component
of sinus function. Cilia lining the walls of the sinuses provide
regular clearance of mucus and debris.5
Anatomy of the upper airway. (Reproduced with permission
from Mckinley M, O’Loughlin VD. Human Anatomy, 2nd ed.
NY: McGraw-Hill; 2008:749.)
Healthy sinuses may produce up to 2 liters of mucus per day that
goes unnoticed. Mucus thickens in response to inflammatory signals
and becomes noticeable in its altered state. The infiltrate and degradation
products associated with inflammation can alter the color of mucus
even in the absence of true infection.
The space known as the middle ear begins at the nasopharyngeal
orifice of the eustachian tube and extends to the air cells of the
mastoid, petrosa, and ...