ABSTRACT
BACKGROUND: Despite the evidence demonstrating that antibiotics are of little benefit in acute rhinosinusitis (ARS), GPs continue to prescribe them, possibly in an attempt to prevent potentially dangerous complications. In this study, we present epidemiological data about the incidence, course and severity of such complications in the Netherlands. METHODS: This retrospective cohort study included all patients hospitalized in The Netherlands in 2004 with a complication of ARS. Records were made of the symptoms of ARS and the complication, demographics, medical history, medical treatment preceding hospitalization, diagnostic techniques, therapeutic management, course and outcome. RESULTS: Forty-seven patients with 48 complications (16 intracranial and 32 orbital) were included. In the intracranial group (mean age 35.9 years), six patients had been treated with oral antibiotics prior to hospitalization. While hospitalized, all patients were treated with intravenous antibiotics and 15 underwent surgery. Eight patients recovered fully after treatment, three patients had residual symptoms and three patients died (missing data: 2). Of the 31 patients with orbital complications (mean age 17.4 years), 14 received oral antibiotics before admission. While hospitalized, all patients were treated with intravenous antibiotics and 13 underwent surgery. Twenty-seven patients recovered fully and two had residual symptoms (missing data: 2). CONCLUSIONS: Severe ARS complications occur in an otherwise healthy population in an estimated 1:12,000 paediatric and 1:32,000 adult cases in the Netherlands. Our study suggests that antibiotic treatment of ARS in general practice does not play a role in preventing complications.
Subject(s)
Rhinitis/complications , Sinusitis/complications , Acute Disease , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Female , Fever/etiology , Headache/etiology , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Netherlands/epidemiology , Retrospective Studies , Rhinitis/drug therapy , Rhinitis/epidemiology , Sinusitis/drug therapy , Sinusitis/epidemiology , Young AdultABSTRACT
BACKGROUND: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. METHODS: On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. RESULTS: There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. CONCLUSION: Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.
