THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Sinusitis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-82994-2 1. Sinusitis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of sinusitis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to sinusitis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to sinusitis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Common Cold
·
The Official Patient's Sourcebook on Flu
·
The Official Patient's Sourcebook on Pneumonia
·
The Official Patient's Sourcebook on Primary Immunodeficiency
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 5
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON SINUSITIS: GUIDELINES ................... 9
Overview............................................................................................................... 9 What Is Sinusitis? .............................................................................................. 10 What Are Sinuses? ............................................................................................. 11 What Are the Symptoms of Sinusitis? ............................................................... 12 What Are Some Causes of Acute Sinusitis?....................................................... 13 What Causes Chronic Sinusitis?........................................................................ 14 How Is Sinusitis Diagnosed? ............................................................................. 14 How Is Sinusitis Treated? .................................................................................. 15 How Can I Prevent Sinusitis? ........................................................................... 17 Research .............................................................................................................. 18 Where Can I Get More Information about Sinusitis?........................................ 18 More Guideline Sources ..................................................................................... 19 Vocabulary Builder............................................................................................. 27
CHAPTER 2. SEEKING GUIDANCE ....................................................... 31
Overview............................................................................................................. 31 Associations and Sinusitis.................................................................................. 31 Finding Doctors.................................................................................................. 33 Finding Specialists.............................................................................................. 34 Selecting Your Doctor ........................................................................................ 35 Working with Your Doctor ................................................................................ 36 Broader Health-Related Resources ..................................................................... 37
CHAPTER 3. CLINICAL TRIALS AND SINUSITIS ................................... 39
Overview............................................................................................................. 39 Recent Trials on Sinusitis .................................................................................. 42 Benefits and Risks............................................................................................... 46 Keeping Current on Clinical Trials.................................................................... 49 General References.............................................................................................. 50 Vocabulary Builder............................................................................................. 51
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 53 CHAPTER 4. STUDIES ON SINUSITIS ..................................................... 55
Overview............................................................................................................. 55
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The Combined Health Information Database ..................................................... 55 Federally-Funded Research on Sinusitis ............................................................ 60 E-Journals: PubMed Central .............................................................................. 70 The National Library of Medicine: PubMed ...................................................... 72 Vocabulary Builder............................................................................................. 73
CHAPTER 5. PATENTS ON SINUSITIS ................................................... 81
Overview............................................................................................................. 81 Patents on Sinusitis............................................................................................ 82 Patent Applications on Sinusitis........................................................................ 88 Keeping Current ................................................................................................. 91 Vocabulary Builder............................................................................................. 91
CHAPTER 6. BOOKS ON SINUSITIS ....................................................... 93
Overview............................................................................................................. 93 Book Summaries: Federal Agencies .................................................................... 93 Book Summaries: Online Booksellers ................................................................. 95 The National Library of Medicine Book Index ................................................... 99 Chapters on Sinusitis ....................................................................................... 102 General Home References ................................................................................. 106 Vocabulary Builder........................................................................................... 107
CHAPTER 7. MULTIMEDIA ON SINUSITIS .......................................... 115
Overview........................................................................................................... 115 Bibliography: Multimedia on Sinusitis ............................................................ 115
CHAPTER 8. PERIODICALS AND NEWS ON SINUSITIS ....................... 119
Overview........................................................................................................... 119 News Services & Press Releases ....................................................................... 119 Newsletter Articles ........................................................................................... 128 Academic Periodicals covering Sinusitis.......................................................... 129 Vocabulary Builder........................................................................................... 130
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 133
Overview........................................................................................................... 133 NIH Guidelines................................................................................................. 133 NIH Databases.................................................................................................. 134 Other Commercial Databases ........................................................................... 138 The Genome Project and Sinusitis ................................................................... 138 Specialized References....................................................................................... 143 Vocabulary Builder........................................................................................... 144
CHAPTER 10. DISSERTATIONS ON SINUSITIS ..................................... 145
Overview........................................................................................................... 145 Dissertations on Sinusitis ................................................................................ 145 Keeping Current ............................................................................................... 146
PART III. APPENDICES .................................................. 147 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 149
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Overview........................................................................................................... 149 Your Medications: The Basics .......................................................................... 150 Learning More about Your Medications .......................................................... 151 Commercial Databases...................................................................................... 157 Contraindications and Interactions (Hidden Dangers) ................................... 163 A Final Warning .............................................................................................. 164 General References............................................................................................ 164 Vocabulary Builder........................................................................................... 165
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 169
Overview........................................................................................................... 169 What Is CAM? ................................................................................................. 169 What Are the Domains of Alternative Medicine?............................................ 170 Can Alternatives Affect My Treatment? ......................................................... 173 Finding CAM References on Sinusitis............................................................. 174 Additional Web Resources................................................................................ 179 General References............................................................................................ 191 Vocabulary Builder........................................................................................... 191
APPENDIX C. RESEARCHING NUTRITION ......................................... 193
Overview........................................................................................................... 193 Food and Nutrition: General Principles........................................................... 194 Finding Studies on Sinusitis ............................................................................ 198 Federal Resources on Nutrition........................................................................ 202 Additional Web Resources................................................................................ 202 Vocabulary Builder........................................................................................... 204
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 207
Overview........................................................................................................... 207 Preparation ....................................................................................................... 207 Finding a Local Medical Library ...................................................................... 208 Medical Libraries Open to the Public............................................................... 208
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 215
Overview........................................................................................................... 215 Your Rights as a Patient................................................................................... 215 Patient Responsibilities .................................................................................... 219 Choosing an Insurance Plan............................................................................. 220 Medicare and Medicaid .................................................................................... 222 NORD’s Medication Assistance Programs ..................................................... 225 Additional Resources ........................................................................................ 226 Vocabulary Builder........................................................................................... 227
ONLINE GLOSSARIES.................................................... 229 Online Dictionary Directories.......................................................................... 235
SINUSITIS GLOSSARY ................................................... 237 General Dictionaries and Glossaries ................................................................ 260
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Contents
INDEX................................................................................... 262
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Sinusitis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Sinusitis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to sinusitis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on sinusitis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on sinusitis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching sinusitis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to sinusitis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating sinusitis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with sinusitis. Part II moves on to advanced research dedicated to sinusitis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on sinusitis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with sinusitis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with sinusitis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with sinusitis.
Scope While this sourcebook covers sinusitis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that sinusitis is often considered a synonym or a condition closely related to the following: ·
Acute Sinusitis
·
Chronic Sinus Infection
·
Chronic Sinusitis
4
Sinusitis
·
Ethmoid Sinuses
·
Frontal Sinuses
·
Maxillary Sinuses
·
Rhinosinusitis
·
Sinus Infection
·
Sphenoid Sinuses
In addition to synonyms and related conditions, physicians may refer to sinusitis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for sinusitis:4 ·
117.9 sinusitis (fungal)
·
461.0 maxillary
·
461.1 frontal
·
461.2 ethmoidal
·
461.3 sphenoidal
·
461.8 other acute sinusitis (pansinusitis)
·
461.9 acute sinusitis
·
473.0 chronic maxillary sinusitis
·
473.9 sinusitis (chronic)
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to sinusitis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with sinusitis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with sinusitis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of sinusitis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on sinusitis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of sinusitis to you or even given you a pamphlet or brochure describing sinusitis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON SINUSITIS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on sinusitis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on sinusitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on sinusitis. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with sinusitis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
·
Centers for Disease Control and Prevention: various fact sheets on infectious diseases at http://www.cdc.gov/health/diseases.htm
Among the above, the National Institute of Allergy and Infectious Diseases (NIAID) is particularly noteworthy. The mission of the NIAID is to provide support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunologic and allergic diseases that afflict people worldwide.6 The NIAID is composed of four extramural divisions: the Division of AIDS; the Division of Allergy, Immunology and Transplantation; the Division of Microbiology and Infectious Diseases; and the Division of Extramural Activities. In addition, NIAID scientists conduct intramural research in laboratories located in Bethesda, Rockville and Frederick, Maryland, and in Hamilton, Montana. The following patient guideline was recently published by the NIAID on sinusitis.
What Is Sinusitis?7 You’re coughing and sneezing and tired and achy. You think that you might be getting a cold. Later, when the medicines you’ve been taking to relieve the symptoms of the common cold are not working and you’ve now got a This paragraph has been adapted from the NIAID: http://www.niaid.nih.gov/facts/overview.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from The National Institute of Allergy and Infectious Diseases (NIAID): http://www.niaid.nih.gov/factsheets/sinusitis.htm. 6
Guidelines 11
terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms, examining your face and forehead, and perhaps doing a sinus X-ray, the doctor says you have sinusitis. Sinusitis simply means your sinuses are infected or inflamed, but this gives little indication of the misery and pain this condition can cause. Health care experts usually divide sinusitis cases into ·
Acute, which lasts for 3 weeks or less
·
Chronic, which usually lasts for 3 to 8 weeks but can continue for months or even years
·
Recurrent, which is several acute attacks within a year
Health care experts estimate that 37 million Americans are affected by sinusitis every year. Health care workers report 33 million cases of chronic sinusitis to the U.S. Centers for Disease Control and Prevention annually. Americans spend millions of dollars each year for medications that promise relief from their sinus symptoms.
What Are Sinuses? Sinuses are hollow air spaces in the human body. When people say, “I’m having a sinus attack,” they usually are referring to symptoms in one or more of four pairs of cavities, or sinuses, known as paranasal sinuses. These cavities, located within the skull or bones of the head surrounding the nose, include the: ·
Frontal sinuses over the eyes in the brow area
·
Maxillary sinuses inside each cheekbone
·
Ethmoid sinuses just behind the bridge of the nose and between the eyes
·
Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes
Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose-an infection, an allergic reaction, or an immune reaction-also can affect the sinuses. Air trapped within a blocked sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering
12 Sinusitis
a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.
What Are the Symptoms of Sinusitis? The location of your sinus pain depends on which sinus is affected. ·
Headache when you wake up in the morning is typical of a sinus problem.
·
Pain when your forehead over the frontal sinuses is touched may indicate that your frontal sinuses are inflammed.
·
Infection in the maxillary sinuses can cause your upper jaw and teeth to ache and your cheeks to become tender to the touch.
·
Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell, and a stuffy nose.
Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head. Most people with sinusitis, however, have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed. Other symptoms of sinusitis can include: ·
Fever
·
Weakness
·
Tiredness
·
A cough that may be more severe at night
·
Runny nose (rhinitis) or nasal congestion
In addition, the drainage of mucus from the sphenoids or other sinuses down the back of your throat (postnasal drip) can cause you to have a sore throat. Mucus drainage also can irritate the membranes lining your larynx (upper windpipe). Not everyone with these symptoms, however, has sinusitis.
Guidelines 13
On rare occasions, acute sinusitis can result in brain infection and other serious complications.
What Are Some Causes of Acute Sinusitis? Most cases of acute sinusitis start with a common cold, which is caused by a virus. These viral colds do not cause symptoms of sinusitis, but they do inflame the sinuses. Both the cold and the sinus inflammation usually go away without treatment in 2 weeks. The inflammation, however, might explain why having a cold increases your likelihood of developing acute sinusitis. For example, your nose reacts to an invasion by viruses that cause infections such as the common cold or flu by producing mucus and sending white blood cells to the lining of the nose, which congest and swell the nasal passages. When this swelling involves the adjacent mucous membranes of your sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. When your sinus openings become too narrow, mucus cannot drain properly. This increase in mucus sets up prime conditions for bacteria to multiply. Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no problems until the body’s defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. Thus, bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute sinus infection. Sometimes, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus, can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi. Chronic inflammation of the nasal passages also can lead to sinusitis. If you have allergic rhinitis or hay fever, you can develop episodes of acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.
14 Sinusitis
Acute sinusitis is much more common in some people than in the general population. For example, sinusitis occurs more often in people who have reduced immune function (such as those with immune deficiency diseases or HIV infection) and with abnormality of mucus secretion or mucus movement (such as those with cystic fibrosis).
What Causes Chronic Sinusitis? If you have asthma, an allergic disease, you may have frequent episodes of chronic sinusitis. If you are allergic to airborne allergens, such as dust, mold, and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis. In addition, people who are allergic to fungi can develop a condition called “allergic fungal sinusitis.” If you are subject to getting chronic sinusitis, damp weather, especially in northern temperate climates, or pollutants in the air and in buildings also can affect you. Like acute sinusitis, you might develop chronic sinusitis if you have an immune deficiency disease or an abnormality in the way mucus moves through and from your respiratory system (e.g., immune deficiency, HIV infection, and cystic fibrosis). In addition, if you have severe asthma, nasal polyps (small growths in the nose), or a severe asthmatic response to aspirin and aspirin-like medicines such as ibuprofen, you might have chronic sinusitis often.
How Is Sinusitis Diagnosed? Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold. Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, and taking X-rays, and if necessary, an MRI or CT scan (magnetic resonance imaging and computed tomography).
Guidelines 15
How Is Sinusitis Treated? After diagnosing sinusitis and identifying a possible cause, a doctor can suggest treatments that will reduce your inflammation and relieve your symptoms.
Acute Sinusitis If you have acute sinusitis, your doctor may recommend ·
Decongestants to reduce congestion
·
Antibiotics to control a bacterial infection, if present
·
Pain relievers to reduce any pain
You should, however, use over-the-counter or prescription decongestant nose drops and sprays for only few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages. If bacteria cause your sinusitis, antibiotics used along with a nasal or oral decongestant will usually help. Your doctor can prescribe an antibiotic that fights the type of bacteria most commonly associated with sinusitis. Many cases of acute sinusitis will end without antibiotics. If you have allergic disease along with infectious sinusitis, however, you may need medicine to relieve your allergy symptoms. If you already have asthma then get sinusitis, you may experience worsening of your asthma and should be in close touch with your doctor. In addition, your doctor may prescribe a steroid nasal spray, along with other treatments, to reduce your sinus congestion, swelling, and inflammation.
Chronic Sinusitis Doctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after taking antibiotics for a long period. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis.
16 Sinusitis
Some people with severe asthma have dramatic improvement of their symptoms when their chronic sinusitis is treated with antibiotics. Doctors commonly prescribe steroid nasal sprays to reduce inflammation in chronic sinusitis. Although doctors occasionally prescribe them to treat people with chronic sinusitis over a long period, they don’t fully understand the long-term safety of these medications, especially in children. Therefore, doctors will consider whether the benefits outweigh any risks of using steroid nasal sprays. If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked. Although home remedies cannot cure sinus infection, they might give you some comfort. ·
Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities.
·
Saline nasal spray, which you can buy in a drug store, can give relief.
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Gentle heat applied over the inflamed area is comforting.
When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life. In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages. Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms. The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.
Guidelines 17
How Can I Prevent Sinusitis? Although you cannot prevent all sinus disorders-any more than you can avoid all colds or bacterial infections-you can do certain things to reduce the number and severity of the attacks and possibly prevent acute sinusitis from becoming chronic. ·
You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
·
Air conditioners help to provide an even temperature.
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Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.
If you are prone to getting sinus disorders, especially if you have allergies, you should avoid cigarette smoke and other air pollutants. If your allergies inflame your nasal passages, you are more likely to have a strong reaction to all irritants. If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger an upper respiratory reaction-you should consult your doctor. Your doctor can use various tests to determine whether you have an allergy and its cause. This will help you and your doctor take appropriate steps to reduce or limit your allergy symptoms. Drinking alcohol also causes nasal and sinus membranes to swell. If you are prone to sinusitis, it may be uncomfortable for you to swim in pools treated with chlorine, since it irritates the lining of the nose and sinuses. Divers often get sinus congestion and infection when water is forced into the sinuses from the nasal passages. You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head blocking your sinuses or eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane’s ascent or descent. Some doctors recommend using decongestant nose drops or inhalers before your flight to avoid this problem.
18 Sinusitis
Research Scientific studies have shown a close relationship between having allergic rhinitis and chronic sinusitis. In fact, some studies state that up to 80 percent of adults with chronic sinusitis also had allergic rhinitis. There is also an association between asthma and sinusitis. Some researchers think that as many as 75 percent of people with asthma also get sinusitis. The National Institute of Allergy and Infectious Diseases (NIAID) conducts and supports research on allergic diseases as well as bacteria and fungus that can cause sinusitis. This research is focused on developing better treatments and ways to prevent these diseases. Scientists supported by NIAID and other institutions are investigating whether chronic sinusitis has genetic causes. They have found that the alterations in genes which cause cystic fibrosis may also contribute to chronic sinusitis. This research focus will give scientists new insights into the cause of the disease in some people and points to new strategies for diagnosis and treatment. Another NIAID-supported research study is trying to determine whether fungi may play a role in causing many cases of chronic sinusitis. This research also will help scientists develop better medicines to treat chronic sinusitis.
Where Can I Get More Information about Sinusitis? For more information, contact: MEDLINEplus National Library of Medicine http://www.nlm.nih.gov/medlineplus/sinusitis.html American Academy of Allergy, Asthma and Immunology 611 East Wells Street Milwaukee, WI 53202 1-800-822-ASMA (2762) http://www.aaaai.org/public/default.stm Joint Council of Allergy, Asthma, and Immunology 50 N. Brockway, Suite 3.3 Palatine, IL 60067
Guidelines 19
(847) 934-1918 http://www.jcaai.org American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street Alexandria, VA 22314-3357 (703) 836-4444 http://www.entnet.org/patient.html
More Guideline Sources The guideline above on sinusitis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to sinusitis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with sinusitis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to sinusitis: ·
Guides On sinusitis Sinusitis http://www.nlm.nih.gov/medlineplus/ency/article/000647.htm Sinusitis http://www.nlm.nih.gov/medlineplus/sinusitis.html
20 Sinusitis
Sinusitis - chronic http://www.nlm.nih.gov/medlineplus/ency/article/000677.htm ·
Other Guides Sinus Surgery http://www.nlm.nih.gov/medlineplus/tutorials/sinussurgeryloader .html Epidural abscess http://www.nlm.nih.gov/medlineplus/ency/article/001416.htm Brain abscess http://www.nlm.nih.gov/medlineplus/ency/article/000783.htm Allergy http://www.nlm.nih.gov/medlineplus/allergy.html Common Cold http://www.nlm.nih.gov/medlineplus/commoncold.html Wegener's granulomatosis http://www.nlm.nih.gov/medlineplus/ency/article/000135.htm Nose Disorders http://www.nlm.nih.gov/medlineplus/nosedisorders.html
Within the health topic page dedicated to sinusitis, the following was recently recommended to patients: ·
General/Overviews 20 Questions About Your Sinuses Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/sinus_questions.cfm Sinusitis Source: American Academy of Family Physicians http://familydoctor.org/handouts/686.html
·
Diagnosis/Symptoms Introduction to Nasal Endoscopy Source: American Rhinologic Society http://american-rhinologic.org/cgibin/menu.cgi?m=main.menu&state=1001125555100000001000000&cit em=7&f=patientinfo.introendoscopy.phtml
Guidelines 21
Sinusitis Diagnosis Source: American Rhinologic Society http://american-rhinologic.org/cgibin/menu.cgi?m=main.menu&state=1002225555100000001000000&cit em=7&f=patientinfo.diagnosis.phtml ·
Treatment Antibiotics and Sinusitis Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/antibiotics_sinusitis.cfm Nasal Sprays: How To Use Them Correctly Source: American Academy of Family Physicians http://familydoctor.org/handouts/104.html Outcomes for Treating Sinusitis Similar With Newer, More Expensive Antibiotics as With Older, Less Expensive Antibiotics Source: American Medical Association http://medem.com/medlb/article_detaillb.cfm?article_ID=ZZZPIO NJXSC&sub_cat=623 Sinus Pain: Can Over-the-Counter Medications Help? Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/sinus_pain.cfm Sinus Surgery http://www.nlm.nih.gov/medlineplus/tutorials/sinussurgeryloader .html Sinus Surgery Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/sinus_surgery.cfm
·
Specific Conditions/Aspects Fungal Sinusitis Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/fungal_sinusitis.cfm
22 Sinusitis
Headache and Sinus Disease Source: American Rhinologic Society http://american-rhinologic.org/cgibin/menu.cgi?m=main.menu&state=1002225555100000001000000&cit em=7&f=patientinfo.headache.phtml Post-Nasal Drip Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://entnet.org/healthinfo/nose/nasal.cfm ·
Children Sinusitis Source: Nemours Foundation http://kidshealth.org/parent/infections/bacterial_viral/sinusitis.html When Sinuses Attack! Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/sick/sinuses.html
·
From the National Institutes of Health Sinusitis Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/factsheets/sinusitis.htm
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Latest News Hum for Your Health! It May Help Your Sinuses Source: 07/22/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_8632.html
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Organizations American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/
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Pictures/Diagrams Normal Sinuses Source: American Academy of Otolaryngology-Head and Neck Surgery, Inc. http://www.entnet.org/healthinfo/sinus/normal_sinus.cfm
Guidelines 23
·
Research Gene Alterations for Cystic Fibrosis May Also Account for Chronic Sinus Problems in Some Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/newsroom/releases/cf-sinus.htm
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Statistics FASTATS: Chronic Sinusitis Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/sinuses.htm
·
Teenagers Sinusitis Source: Nemours Foundation http://kidshealth.org/teen/infections/common/sinusitis.html
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following: http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on sinusitis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits.
24 Sinusitis
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “sinusitis” or synonyms. The following was recently posted: ·
ACR Appropriateness Criteria™ for sinusitis in the pediatric population. Source: American College of Radiology.; 1995 (revised 1999); 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1711&sSearch_string=sinusitis
·
Acute rhinosinusitis in adults. Source: University of Michigan Health System.; 1996 May (revised 1999 Dec); 7 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1511&sSearch_string=sinusitis
·
Acute sinusitis in adults. Source: Institute for Clinical Systems Improvement.; 1995 July (revised 2001 Aug); 28 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2250&sSearch_string=sinusitis
·
Clinical practice guideline: management of sinusitis. Source: American Academy of Pediatrics.; 2001 September; 11 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2162&sSearch_string=sinusitis
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Evidence based clinical practice guideline for children with acute bacterial sinusitis in children 1 to 18 years of age. Source: Cincinnati Children's Hospital Medical Center.; 2001; 16 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2344&sSearch_string=sinusitis
Guidelines 25
·
Parameters for the diagnosis and management of sinusitis. Source: American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology/Joint Council of Allergy, Asthma and Immunology.; 1998 December; 37 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1103&sSearch_string=sinusitis
·
Principles of appropriate antibiotic use for acute sinusitis in adults. Source: American College of Physicians-American Society of Internal Medicine.; 2001 March 20; 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1969&sSearch_string=sinusitis
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment Summary: Discussion on cost-effective diagnosis and treatment of acute sinusitis. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4280
·
Sinusitis Summary: Sinusitis simply means inflammation of the sinuses, but this gives little indication of the misery and pain this condition can cause. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1079
26 Sinusitis
·
Sinusitis Fact Sheet Summary: Patient education pamphlet provides a general overview of acute sinusitis, including treatment. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4281
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to sinusitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
Guidelines 27
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Decongestant: An agent that reduces congestion or swelling. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fungus: A general term used to denote a group of eukaryotic protists,
28 Sinusitis
including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an
Guidelines 29
oral medication or an oral thermometer. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Vasomotor: 1. affecting the calibre of a vessel, especially of a blood vessel. 2. any element or agent that effects the calibre of a blood vessel. [EU]
30 Sinusitis
Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 31
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with sinusitis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with sinusitis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Sinusitis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
32 Sinusitis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about sinusitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “sinusitis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “sinusitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making
Seeking Guidance 33
these selections and typing in “sinusitis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with sinusitis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “sinusitis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with sinusitis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
34 Sinusitis
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding Specialists The American Academy of Allergy, Asthma, and Immunology (AAAAI) maintains a Physician Referral System on its Web site (http://www.aaaai.org/). The Referral System contains contact information for the organization’s 6,000 members, all medical professionals specializing in the treatment of allergies, asthma, or infectious diseases. To use this free service, go to the search form located at http://www.aaaai.org/scripts/find-adoc/main.asp and select the search criteria you would like to use by clicking on the circle to the left of the option. Then type in the information you are While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
Seeking Guidance 35
looking for such as the physician’s location, zip code, name, or specialty. Click the “Search” button. If your query returns information about particular physicians, click on the physician’s name for more information. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about sinusitis?
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Really listen to my questions?
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Answer in terms I understood?
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Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for sinusitis?
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Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
36 Sinusitis
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
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It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
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Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
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Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
Seeking Guidance 37
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 39
CHAPTER 3. CLINICAL TRIALS AND SINUSITIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning sinusitis.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for sinusitis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
40 Sinusitis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on sinusitis.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for sinusitis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on sinusitis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on sinusitis. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
Clinical Trials 41
treatment, like a placebo, has no effect on sinusitis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how sinusitis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for sinusitis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
42 Sinusitis
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Sinusitis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to sinusitis.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Steroids and Methotrexate to Treat Systemic Vasculitis Condition(s): Inflammation; Vasculitis; Wegener's Granulomatosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will evaluate the safety and effectiveness of prednisone and methotrexate in treating severe Wegener's granulomatosis and other systemic vasculitides. These diseases involve inflammation of blood vessels (vasculitis) that may affect the brain, nerves, eyes, sinuses, lungs, kidneys, intestinal tract, skin, joints, heart and other sites. Current treatment with prednisone and the anti-cancer drug cyclophosphamide is effective, but has significant side effects and a high rate of disease recurrence. In a small number of patients with vasculitis, prednisone and methotrexate, another anti-cancer drug, have led to marked improvement, with fewer side effects than are seen with cyclophosphamide. This study will evaluate this drug combination in a larger patient population. Patients 10 to 80 years of age with active
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 43
Wegener's granulomatosis, polyarteritis nodosa, Churg-Strauss vasculitis, or microscopic polyangiitis overlap may be eligible for this 2 1/2 to 3year study. In addition, patients with glomerulonephritis (a type of kidney disease) and a positive blood test for C-ANCA (antibodies found in certain vasculitic kidney diseases) or inflammatory sinusitis or lung nodule or infiltrates in the absence of infection may also be enrolled. Participants will take prednisone daily, by mouth, and low-dose methotrexate weekly, by mouth or by injection either under the skin, into a muscle or into a vein. Patients who significantly improve with treatment will gradually reduce, and eventually stop, the prednisone. If the remission lasts, methotrexate will also be reduced and stopped after 2 1/2 years. If active disease recurs, the original treatment program may be started again. Patients who never achieve complete remission with treatment but whose symptoms are well controlled and experience no serious side effects may choose to either continue low-dose methotrexate or stop therapy. Patients will be hospitalized 4 to 6 times a year, about 2 to 8 days each time, depending on their disease severity and response to illness. In addition, they will have the following tests and procedures: Medical history and physical examination (upon admission to the study and then every 1 to 3 months). - Blood tests for blood cell counts and for levels of enzymes that indicate liver damage (upon admission, then weekly, and finally, no less than monthly). - Additional blood tests to measure blood chemistries and evaluate kidney function (upon admission and again when clinically indicated). - Chest X-rays (upon admission and when clinically indicated). - Computerized tomography (CT) and magnetic resonance imaging (as needed). - Electrocardiogram (upon admission and then as clinically indicated). - Lung function studies (upon admission and at least every 6 months or as clinically indicated). Ear, nose and throat evaluations (as clinically indicated). - Liver biopsy, if blood tests to monitor liver function are persistently abnormal. This procedure is done in the hospital under sedation to induce relaxation and drowsiness. The skin over the liver (upper right abdomen) is numbed with a local anesthetic and a needle is passed rapidly in and out of the liver to collect a small tissue sample for microscopic examination. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010
44 Sinusitis
Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001256;jsessionid=98A074 83254937238256F19529625320 ·
Acupuncture and Herbal Treatment of Chronic HIV Sinusitis Condition(s): HIV Infections; Sinusitis Study Status: This study is completed. Sponsor(s): Immune Enhancement Project Purpose - Excerpt: To compare Traditional Chinese Medicine versus standard antibiotic therapy consisting of pseudoephedrine ( Sudafed ) plus amoxicillin / clavulanate potassium combination ( Augmentin ) in reducing symptoms and recurrence of acute HIV-related sinusitis. Chronic sinusitis in HIV-infected individuals is a recurrent and persistent infection with potentially serious complications: it can exacerbate pulmonary disease, cause recurrences of life-threatening sepsis, and progress to central nervous system involvement. Symptoms of sinusitis in HIV patients are often refractory to aggressive Western medical management, and antibiotic intolerance can occur. Traditional Chinese Medicine consisting of acupuncture and herbal treatment may provide a low-risk, low-cost alternative to conventional antibiotic therapy. Study Type: Interventional Contact(s): California; Immune Enhancement Project, San Francisco, California, 94114, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00002149;jsessionid=98A074 83254937238256F19529625320
·
Immunologic aspects of the pathogenesis of chronic sinusitis in children Condition(s): Sinusitis Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: Chronic sinusitis is a common pediatric disease; it ranks among the top five infectious diseases of the upper respiratory tract. Its treatment is limited and may be due largely in part to a lack of understanding of its cause. The investigators have preliminary data to support the notion that pediatric chronic sinusitis is a distinct disease, different from acute sinusitis and adult chronic sinusitis. We are proposing to perform pathogenesis studies in children with chronic
Clinical Trials 45
sinusitis. Specifically, we wish to elucidate the microbiologic features and immunologic factors involved in the formation of this disease. The study plan calls for microbiologic (bacterial, viral, and fungal) and immunologic (inflammatory mediators and leukocyte populations) data to be evaluated through a maxillary sinus washing and mucosal biopsies. Four populations will be studied and they are: 10 children with chronic sinusitis, 5 children with acute sinusitis (positive control), 5 children without sinusitis (negative control) and 5 adults with chronic sinusitis (positive secondary control). Study Type: Interventional Contact(s): Kenny H. Chan, M.D. 1-303-764-8520; Colorado; The Children's Hospital, Denver, Colorado, 80218, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004638;jsessionid=98A074 83254937238256F19529625320 ·
Preventing Frequent Sinus Infections in HIV-Infected Patients Condition(s): HIV Infections; Sinusitis Study Status: This study is terminated. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); Adams Laboratories; Glaxo Wellcome Purpose - Excerpt: To evaluate the additional effectiveness of an antiinflammatory nasal spray ( beclomethasone dipropionate ) and a broad spectrum antibiotic ( cefuroxime axetil ) over decongestant ( Deconsal II ) alone, when these agents are given individually or in combination for the prevention of recurrent paranasal sinus infection in patients with HIV infection. To compare the clinical utility of paranasal sinus radiographs with computed tomograms (CTs) in the evaluation and management of HIV-infected patients with recurrent paranasal sinus infection. To determine relevant prognostic factors and the microbiologic etiology of maxillary sinusitis in this patient population. Sinusitis is common among HIV-infected patients and is likely to be recurrent or refractory to traditional therapy, particularly in patients with advanced immunosuppression. An intervention aimed at prevention of recurrent sinus disease in HIV-infected patients appears to be warranted. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below
46 Sinusitis
Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000752;jsessionid=98A074 83254937238256F19529625320
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for sinusitis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with sinusitis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17
Clinical Trials 47
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.
How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
48 Sinusitis
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?
In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Questions Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
·
What are the standard treatments for sinusitis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
·
How long will the treatment last? How often will I have to come back for follow-up exams?
·
What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
Clinical Trials 49
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
·
How will my health be monitored?
·
Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
·
Will I be able to see my own doctor? Who will be in charge of my care?
·
Will taking part in the study affect my daily life? Do I have time to participate?
·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “sinusitis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
50 Sinusitis
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
Clinical Trials 51
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to betalactamase. It has been proposed for infections with gram-negative and grampositive organisms, gonorrhea, and haemophilus. [NIH] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a
52 Sinusitis
specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Pulmonary: Pertaining to the lungs. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refractory: Not readily yielding to treatment. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Vasculitis: Inflammation of a vessel, angiitis. [EU]
53
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on sinusitis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on sinusitis. In Part II, as in Part I, our objective is not to interpret the latest advances on sinusitis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with sinusitis is suggested.
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CHAPTER 4. STUDIES ON SINUSITIS Overview Every year, academic studies are published on sinusitis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on sinusitis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on sinusitis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and sinusitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “sinusitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Sinusitis: Bench to Bedside. Current Findings, Future Directions Source: Otolaryngology-Head and Neck Surgery. 116(6, Part 2, Supplement): S1-S20. June 1997. Summary: This journal supplement presents the proceedings of a conference on Sinusitus, held in January 1996, that was jointly sponsored by the American Academy of Allergy, Asthma and Immunology and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. This document summarizes the proceedings of that meeting and presents what is intended to be the background for future investigation of the many unanswered questions related to sinusitis. Critical questions remain unanswered about the cause, pathophysiology, and optimal treatment of sinusitis, and sinusitis continues to generate significant health care costs and to affect the quality of life for a large segment of the U.S. population. The authors explore the recent advances in the use of endoscopy for diagnosing and treating sinusitus. However, because of the limited time frame for the determination of the long-term results of functional endoscopic surgery, the efficacy of this procedure beyond the first year after surgery is poorly defined. The document concludes with a list of eight recommended areas for future research. 6 tables. 89 references.
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Chronic Sinusitis: Relationship of Computed Tomographic Findings to Allergy, Asthma, and Eosinophilia Source: Journal of the American Medical Association. JAMA. 271(5): 363367. February 2, 1994. Summary: This article reports on a study undertaken to develop a technique for evaluating the severity of chronic sinus disease and to examine the correlation with allergy, asthma, and eosinophilia. The study consisted of a survey of 104 patients undergoing surgery for chronic sinusitis at a university hospital ear, nose, and throat clinic. Outcome measures used included computed tomographic scans, serum samples, peripheral blood samples, and surgical biopsy specimens. Extensive disease was present in 39 percent of subjects and correlated well with
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asthma, specific IgE antibodies, and eosinophilia, but not with elevated total IgE. Among patients with peripheral eosinophilia, 87 percent had extensive disease. The authors present their system for quantitation of disease extent using computed tomographic scans of patients with chronic sinusitis. They conclude that the well-accepted associations of chronic sinusitis with asthma and allergy appear to be restricted to the group with extensive disease. 2 figures. 3 tables. 25 references. (AA-M). ·
Oral and Pharyngeal Complications of Gastroesophageal Reflux Disease: Globus, Dental Erosions, Chronic Sinusitis Source: Journal of Clinical Gastroenterology. 30(3 Supplement): S35-S38. April 2000. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Summary: This article describes the oral and pharyngeal manifestations of gastroesophageal reflux disease (GERD), which are most likely caused by physical contact of regurgitation of gastric content with surface mucosa and as such suggests abnormalities of the airway protective mechanisms. The authors caution that the body of evidence on the causation, and therefore the diagnosis and treatment of these increasingly diagnosed disorders is still evolving. The lack of a clear cause and effect relationship is complicated by the fact that patients with suspected supraesophageal complications of reflux disease frequently lack the characteristic features of esophageal peptic injury, including the most typical symptom of heartburn. These problems often recur, but are usually susceptible to empiric antireflux treatment (for example, with proton pump inhibitors). A detailed patient history may provide important clues to the association of acid reflux and suspected supraesophageal complications. A history of regurgitation, particularly at nighttime, associated with cough or with symptoms suggesting aspiration is a most significant clue to the possibility of supraesophageal complications of GERD. A history of repetitive throat clearing, recurrent hoarseness (particularly in the morning), halitosis (bad breath), or hypersialorrhea (excessive saliva) should also alert the clinician to the possibility of an acid reflux related supraesophageal condition. However, the majority of patients with this condition may have no esophageal symptoms at all. The authors discuss globus pharyngeus, chronic sinusitis, and gastroesophageal reflux and dental erosions, as other possible symptoms. 2 tables. 37 symptoms.
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Oral and Pharyngeal Complications of Gastroesophageal Reflux Disease: Globus, Dental Erosions, and Chronic Sinusitis Source: Journal of Clinical Gastroenterology. 30(3 Supplement): S35-S38. April 2000. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030. Summary: This article reviews the oral and pharyngeal complications of gastroesophageal reflux disease (GERD), including globus, dental erosions, and chronic sinusitis. The authors describe the oral and pharyngeal manifestations of GERD, which are most likely caused by physical contact of regurgitation of gastric content with surface mucosa and as such suggests abnormalities of the airway protective mechanisms. The authors caution that the body of evidence on the causation, and therefore the diagnosis and treatment of these increasingly diagnosed disorders is still evolving. The lack of a clear cause and effect relationship is complicated by the fact that patients with suspected supraesophageal complications of reflux disease frequently lack the characteristic features of esophageal peptic injury, including the most typical symptom of heartburn. These problems often recur, but are usually susceptible to empiric antireflux treatment (for example, with proton pump inhibitors). A detailed patient history may provide important clues to the association of acid reflux and suspected supraesophageal complications. A history of regurgitation, particularly at nighttime, associated with cough or with symptoms suggesting aspiration is a most significant clue to the possibility of supraesophageal complications of GERD. A history of repetitive throat clearing, recurrent hoarseness (particularly in the morning), halitosis (bad breath), or hypersialorrhea (excessive saliva) should also alert the clinician to the possibility of an acid reflux related supraesophageal condition. However, the majority of patients with this condition may have no esophageal symptoms at all. The authors discuss globus pharyngeus, chronic sinusitis, and gastroesophageal reflux and dental erosions, as other possible symptoms. 2 tables. 37 symptoms.
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Rhinosinusitis: Factors and Classifications Source: Bulletin [American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS)]. 17(2): 19. February 1998. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. (AAOHNS). One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. E-mail:
[email protected]. Summary: This single-page fact sheet helps physicians diagnosis and accurately describe the different types of rhinosinusitis. The classification
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system offered is based on a committee consensus; there is no true pathologic classification for adult rhinosinusitis. The fact sheet encourages readers to utilize standard terminology when describing these various forms; this terminology will provide a strong communication framework for clinicians and researchers. The fact sheet lists the major and minor factors associated with chronic rhinosinusitis. Major factors include facial pain or pressure, facial congestion or fullness, nasal obstruction or blockage, nasal discharge, hyposmia (little sense of smell) or anosmia (no sense of smell), and purulence in nasal cavity on examination. The fact sheet also provides, in chart form, the classification, duration, history, and special notes for acute, subacute, recurrent acute, chronic, and acute exacerbations of chronic rhinosinusitis. 1 figure. 1 table. ·
What Role for Antibiotics in Otitis Media and Sinusitis? Source: Postgraduate Medicine. 104(3): 93-99, 103-104. September 1998. Contact: Available from Postgraduate Medicine. P.O. Box 459, Hightstown, NJ 08520-9201. (609) 426-7070. Fax (609) 426-7087. Summary: Patients often expect to be given antibiotics for any illness affecting the ears and sinuses, regardless of whether such treatment is warranted. This article, the fourth of four articles on common ear, nose, and throat (ENT) problems, discusses the role for antibiotics in treating otitis media (middle ear infection) and sinusitis (sinus infection). The authors caution that bacterial resistance to antibiotics is rising. They outline the types of otitis media and sinusitis that should be treatment with antibiotics and the agents that are currently the most effective for each condition. The authors review the established classification and treatment guidelines for these conditions. First-line treatment for both uncomplicated acute otitis media and acute sinusitis is amoxicillin. Erythromycin ethylsuccinate and sulfisoxazole or TMP-SMZ may be used in patients who are allergic to penicillin. Beta-lactamase-stable agents should be given when no response occurs within 48 to 72 hours. In cases where penicillin-resistant pneumococcus is suspected, high-dose amoxicillin, with or without clavulanate, or clindamycin should be considered. Antibiotics are not indicated for initial treatment of otitis media with effusion (OME), but may be considered for effusions lasting longer than 3 months. Prophylactic antibiotics should be considered only for recurrent acute infections occurring three or more times within 6 months or four or more times with a year. 4 tables. 27 references. (AA-M).
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Federally-Funded Research on Sinusitis The U.S. Government supports a variety of research studies relating to sinusitis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to sinusitis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore sinusitis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for sinusitis: ·
Project Title: Allergic Rhinitis Augments Bacterial Sinusitis Principal Investigator & Institution: Naclerio, Robert M.; Professor & Chief; Surgery; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2002 Summary: (provided by applicant): Sinusitis is a major health care problem for Americans of all ages. Despite the significant morbidity it causes and the enormous cost of managing this problem, little progress has been made at improving our basic understanding of its pathophysiology. The main constraints on the study of sinusitis have been the limited access to human sinuses and the lack of a satisfactory animal model that compares favorably with disease in man. Allergic rhinitis, a disease affecting 20 percent of Americans, is considered a major contributing factor to the development of sinusitis. We have developed a mouse model of acute sinusitis. We present data demonstrating the development of acute sinusitis in C57B1/6 and BALB/c mice after instillation ol Streptococcus pneumoniae (S. pneumoniae) (the most
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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common pathogen responsible for acute sinusitis in man), the development of allergic rhinosinusitis in BALB/c mice, and augmentation of infection and of the inflammatory response to infection in BALB/c mice with simultaneous ongoing allergic reactions. With this model, we propose to investigate the interrelationship of allergic rhinitis and sinusitis. Our hypothesis is that the allergic response in the nose affects both the innate immune response and the host?s inflammatory response to clear the infection. Furthermore, we hypothesize that IL-4 released by Th2 cells recruited during the allergic reaction interferes with the recruitment, development, and activation of Th1 cells that contribute to the suppression of infection and inflammation caused by bacterial infection. To test these hypotheses, we propose the following specific aims. In Aim 1, we will investigate the relative importance of the innate immune system and the acquired immune system (i.e., Th1 cells) in reducing the infection arid sinus mucosal inflammation caused by intranasal inoculation of S. pneumoniae. In Aim 2, we will investigate whether Th2 cells are the component of the allergic response that leads to a more severe sinus infection after inoculation with S. pneumoniae. In Aim 3, we will investigate whether the exaggerated response to infection caused by the mucosal allergic response is due to a cytokine imbalance induced by Th2-type cytokines. By manipulating our animal model of sinusitis and exploiting the advantages of using knockout and transgenic mice, we will further increase our understanding of sinusitis and the host factors that contribute to this common disease. Our unique murine model provides the first opportunity to study this major health care problem at a level that was previously unavailable and that could lead to the identification of new treatments. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Chronic Hyperplastic Sinusitis and Asthma Principal Investigator & Institution: Borish, Larry; Associate Professor; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2001; Project Start 4-SEP-2001; Project End 1-AUG2005 Summary: Description (provided by applicant): This project will contribute to the overall objectives of this AADC by focusing on the contribution of sinusitis to the presence and severity of asthma. Sinusitis and asthma are very common conditions characterized by a similar inflammatory infiltrate, but the relationship between them is poorly understood. We have shown that extensive mucosal disease is a major independent risk factor for asthma. This finding could indicate that either
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the two conditions have a common cause or that one is dependent on the other. We will distinguish these possibilities by performing a prospective study on the relationship between sinusitis and asthma. Inherent in these studies is the critical need to develop and validate a methodology for objectively measuring the presence, severity, and clinical course of chronic hyperplastic sinusitis (CHS)/nasal polyposis (NP). As a disease of hyperplastic mucosal tissue with eosinophilia, we will show that the hyperplasia will be readily visualized and accurately quantified by CT scan. We will gain insights into the pathophysiology and interplay of these conditions by identifying changes in the nose and sinuses that correlate with increased inflammation in the lungs during experimental RV infection and nasal allergen challenges. Our proposed mechanism by which RV infection and allergen contribute to inflammation of the sinuses and lungs is that T cells primed in the nares and sinuses can act directly by localizing to the lungs. Alternatively, RV infection and allergen challenge may contribute to eosinophil influx into the airways, derived either from the bone marrow or locally from CD34+ve, IL5Ra+ precursors. Activated lymphocytes and eosinophil precursors, as well as newly generated bone marrow-derived eosinophils, express VLA-4 and, in the presence of pre-existing VCAM-I, will localize in the lung where they will exacerbate inflammation. Finally, we will demonstrate that CHS/NP is characterized by the dysregulation of cysLTs and their receptors. CysLTs promote eosinophil-mediated inflammation, mucous gland secretion, the proliferation of epithelium and endothelium, and they contribute to remodeling and fibrosis. We hypothesize that the modulation of cysLT production and activity by aspirin desensitization will attenuate CHS/NP. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Effect of Sinusitis Treatment On Pediatric Asthma Principal Investigator & Institution: Schechter, Michael S.; ; Wake Forest University Box 7373, Reynolda Sta Winston-Salem, Nc 27109 Timing: Fiscal Year 2000; Project Start 0-SEP-1992; Project End 8-FEB-2001 Summary: Rationale: Up to 50% of asthmatic patients have chronic or recurrent sinus disease. It is commonly claimed that sinusitis causes worsening of asthmatic symptoms, but that belief has never been subjected to rigorous evaluation. Hypothesis: Treatment of acute or subacute sinusitis improves subjective and objective markers of asthma. Subjects: Asthmatic children with CT evidence of sinusitis are the subjects of the study. Methods: Participants are evaluated with a symptom questionnaire, spirometry, plethysmography, methacholine challenge and analysis of nasal washings and sputum. They then receive
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either an antibiotic or placebo in a double-blind manner. The subjects continue on their usual regular asthma medications. After 3-4 weeks, they are re-evaluated to evaluate persisting sinus disease as well as any changes in asthma measures. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Epithelial Function and Dysfunction in Chronic Sinusitis Principal Investigator & Institution: Proud, David; ; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000 Summary: This abstract is not available. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Rhinosinusitis
Epithelian
in
Sinusitis--Mucosa
in
Refractory
Principal Investigator & Institution: Togias, Alkis G.; Associate Professor of Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 1-DEC-1985; Project End 0-NOV2002 Summary: This project, which has just received funding for a second 4year term by the NIAID, is designed to investigate functional abnormalities that may exist in the nasal mucose of patients who suffer from chronic, resistant-to-treatment, rhinosinusitis. Our extensive evaluation of the airways of patients with refractory chronic rhinosinusitis during the first funding period of this project, resulted in an unexpected finding, i.e., in comparision to healthy controls, patients with this condition exhibited nasal mucosal secretory hyporesponsiveness upon localized provocation with histamine. The importance of this phenomenon is accentuated by the concomitant observation that the same patients had excessive mucosal inflammation, documented in nasal fluid cytology. In the case of perennial allergic rhinitis, another chronic inflammatory condition, nasal mucosal inflammation would be associated with mucosal hyperresponsiveness. We now propose that secretory mucosal hyporesponsiveness plays a central pathophysiologic role in patients with refractory rhinosinusitis as it may lead to diminished homeostatis and protective mechanisms against environmental insults such as allergens, irritants and infections. We are now identifying the functional elements of the mucosa that contribute to reduced secretory responsiveness and are investigating the pathophysiologic importance of this phenomenon. Using the technique of
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nasal provocation with stimulants that have specific actions on various mucosal structures, our first aim is to test the hypothesis that the glandular apparatus is mainly responsible for the observed mucosal dysfunction. In our second aim, we will test whether secretory mucosal hyporesponsiveness is a risk factor for worse outcomes after exposure to inducers of allergic, viral and neurogenic inflammation under experimental conditions, as well as a risk factor for poor treatment outcomes. Our third aim will address the hypothesis that secretory mucosal hyporesponsiveness exhibits familial predisposition. This will be tested by comparing the mucosal responsiveness of the siblings of patients with refractory rhinosinusitis to: A) the siblings of a healthy control group, and B) patients with cystic fibrosis, who invariably suffer from refractory rhinosinusitis and have a well characterized genetic defect, and C) the parents of patients with cystic fibrosis who are obligate carriers of CFTR mutations. This project is an integral part of a program project grant, the main hypothesis of which is that epithelial cell/mucosal dysfunction plays a central role in the pathogenesis of chronic rhinosinusitis. This project offers a novel hypothesis on the pathophysiologic mechanism of this condition by focusing around an identified secretory mucosal dysfunction. Establishing such a mechanism may lead to new approaches for the treatment of this major, yet poorly managed, health problem. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Nitric Oxide and Chronic Rhinosinusitis Principal Investigator & Institution: Jacob, Abraham; Otolaryngology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2002 Summary: (provided by applicant): Rhinosinusitis affects about 10% of the U.S. population and is the reason for approximately 12-million physician office visits annually. Obstruction to sinus drainage and immune dysregulation are believed to result in mucosal disruption and hypersecretion, nasal obstruction, postnasal discharge, cough, headache, and facial pressure. Our laboratory has successfully developed and described the first mouse model of chronic rhinosinusitis. Now in press, we plan to use this model to characterize this disease at its molecular and genetic levels. Since the discovery of its role in regulating vascular tone, nitric oxide (NO) and nitric oxide synthase (NOS) have been implicated in neurotransmission, ischemia-reperfusion syndromes, atopic diseases, and chronic inflammatory disorders. During health, it is known that the human paranasal sinuses are the dominant source of nitric oxide in the
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upper airways. However, the diseased state is not well characterized. While chemiluminescense measurements of NO in exhaled air indicate decreased levels during sinusitis, nasal secretions find increased NO metabolite concentrations. Although the literature implicates nitric oxide as a player, there is no consensus as to its precise role or its degree of importance. Further study is necessary. The in vivo analysis of nitric oxide's role in chronic sinonasal disease shall be investigated using 3 experimental groups of mice: C57BL/6 wild-type mice, NOS I, II, and III knockout mice, and C57BL/6 mice infused with aminoguanidine - a panNOS inhibitor. Each of these groups shall be further sub-divided into normal controls, sham-operated controls, and animals with surgically induced sinusitis. All groups and interventions shall be compared at the light microscope level. Histomorphometric analysis of en-bloc sinonasal tissue shall be used to quantify epithelial thickness, cell density, basement membrane thickness, and goblet cell number. Qualitative observations shall assess the presence or absence of inflammatory infiltrates and sinonasal fibrosis. With this approach of inhibiting nitric oxide production at multiple levels -- pharmacologically and with gene knockout -- we hope to better characterize the importance of NO in sinonasal pathophysiology. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pathogenesis of Chronic Sinusitis in Children Principal Investigator & Institution: Chan, Kenny; ; University of Colorado Hlth Sciences Ctr 4200 E 9Th Ave Denver, Co 80262 Timing: Fiscal Year 2000 Summary: Chronic sinusitis is a common pediatric disease; it ranks among the top five infectious diseases of the upper respiratory tract. Its treatment is limited and may due largely in part to a lack of understanding of its pathogenesis. The primary objective of the study was to evaluate the microbiology (through bacteriologic and viral cultures) and local histologic (through maxillary sinus mucosal biopsies) and immunologic (through assays of inflammatory mediators of the maxillary sinus washes) responses in children with chronic sinusitis. The secondary objective was to refine our research methodologies during the course of the study in preparation for a large-scale investigation. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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·
Project Title: Rhinosinusitis
Processes
of
Care
and
Outcomes
in
Chronic
Principal Investigator & Institution: Chin, Kenley W.; Surgery; University of California Los Angeles Box 951361, 405 Hilgard Ave Los Angeles, Ca 90095 Timing: Fiscal Year 2000; Project Start 1-AUG-2000; Project End 0-APR2001 Summary: Dr. Chin is an otolaryngologist-head and neck surgeon completing his second year at the UCLA/RAND Clinical Scholars Program. The K08 Award would allow him to meet his short-term goals of starting an academic career as one of a few formally trained health services researcher/head and neck surgeons in the country. The wellestablished health services research environment at UCLA and at RAND would be the ideal environment for him to pursue his training to the doctoral level with aims of eventually becoming an independent health services researcher. His career development plan includes a comprehensive educational Program detailing advanced doctoral level courses at UCLA and at RAND in health services research methodology combined with his KO8 research project under the continued mentorship of Dr. Katherine Kahn. The KO8 training opportunity will allow him to acquire advanced health services research skills necessary to position himself to make significant contributions to improve the quality of care and outcomes for patients with otolaryngologic diseases. His research proposal addresses chronic rhinosinusitis that was the most common chronic condition reported by outpatients in the 1995 National Health Interview Study (NHIS). As a Clinical Scholar, Dr. Chin conducted over 20 focus group meetings with patients with chronic rhinosinusitis drawn from the UCLA Primary Care Network with a demographic profile similar to the patients reporting chronic rhinosinusitis in the 1995 NHIS. The recent 1999 AHCPR evidence based report on the diagnosis and treatment of sinusitis cited the lack of existing evidence to support specific diagnostic or treatment measures for patients with rhinosinusitis. Consequently, care for rhinosinusitis is currently based on different, and at times conflicting, national consensus-based guidelines. Dr. Chin's research proposal is a prospective study of adult patients with chronic rhinosinusitis to assess variations in care and their relationship to outcomes in terms of disease severity and health related quality of life measured at 6 and 12-month follow-up. This will involve the application of the principles of process and outcomes of care. Processes are defined according to whether patients receive evidence-based measures of care and may include measures derived from different consensus-based clinical guidelines. The analyses of process measures and outcomes will
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be performed stratified and unstratified according to baseline disease severity. Disease severity is defined according to the chronicity, duration, frequency and severity of rhinosinusitis episodes. The findings of the proposal study will provide the basis for understanding patient outcomes in chronic rhinosinusitis in terms of the process of care that patient's receive and explicit disease severity measures. The research skills learned in the process of completing the K08 award will be invaluable and will position him to begin addressing the multitude of fascinating research topics at the interface of health care quality research and diseases of the head and neck. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Relationship between Allergic Rhinitis and Sinusitis Principal Investigator & Institution: Baroody, Fuad M.; Surgery; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2000; Project Start 5-AUG-1999; Project End 1-JUL2004 Summary: Chronic sinusitis was the most frequently reported disease by Americans in the 1993 National Health Interview Survey and is a major contributor to health care costs and decreased productivity. It has recently become apparent that chronic disease is not associated with infection of the paranasal sinuses but is characterized by an eosinophilic/lymphocytic infiltration of the inflamed sinus mucosa. It is also known that there is a close relationship between allergic rhinitis and sinusitis since many subjects with sinusitis are allergic and many allergic subjects suffer from chronic sinus disease. To investigate a potential mechanism for this relationship, we challenged allergic subjects with allergen intranasally and monitored their cellular response in both the nasal and ipsilateral maxillary sinus cavity using lavage. These experiments have yielded exciting preliminary data showing that the number of eosinophils in maxillary sinus secretions increases significantly hours after nasal challenge with allergen but not after sham challenge. Because the nose and the maxillary sinuses are separate cavities, we hypothesize that allergic inflammation in the nose triggers axonal reflexes that lead to the release of neuropeptides within the ipsilateral maxillary sinus cavity. These neuropeptides act locally and promote mediator release from sinus resident cells that result in eosinophil recruitment into the sinus cavity in the hours after allergen challenge of the nose. We hypothesize that histamine, leukotrienes and interleukin 5 produced into the nose and the maxillary sinus will be important for the generation of the eosinophilic response. We will test this hypothesis by measuring these mediators and neuropeptides in
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maxillary sinus lavages after nasal challenge with allergen and capsaicin, a substance that triggers an axonal reflex. We will also attempt to block the eosinophilic response by local anesthetics and specific receptor antagonists for leukotrienes and histamine. The effect of ongoing allergic or sinus inflammation on the eosinophilic sinus response will also be studied by comparing the response of allergic subjects in and out of their allergy season and subjects with and without chronic sinusitis. Completing this proposal will not only help elucidate the mechanisms underlying the close association between allergic rhinitis and chronic sinusitis but will also be helpful in furthering our understanding of the pathophysiology of the inflammatory response within the paranasal sinuses. This will hopefully help to improve our therapeutic modalities for this enigmatic illness that affects millions of Americans every year. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: the Pathogenesis of Chronic Sinusitis Principal Investigator & Institution: Douglas, James S.; Fellow; John B. Pierce Laboratory, Inc. 290 Congress Ave New Haven, Ct 06519 Timing: Fiscal Year 2001; Project Start 1-APR-2001; Project End 1-MAR2003 Summary: (Applicant's Abstract): The long-term objectives of this proposal are to characterize the physiological, biochemical and pathological changes that occur in the maxillary sinuses of individuals with clinically diagnosed chronic sinus disease. The hypotheses are based on the observation that nitric oxide is present in high concentrations in the nose of normal individuals but not in sinusitis patients. We hypothesize that, in response to a viral and/or bacterial infection, ciliated epithelial cells lining the sinus generate cytokines. There follows an infiltration of activated inflammatory cells, mainly neutrophils that generate superoxide. In the unique environment of the sinus, i.e. high nitric oxide concentration, the superoxide free radical preferentially reacts with nitric oxide to generate the highly cytotoxic peroxynitrite species rather than with its natural scavenger, superoxide dismutase. We suggest that the ensuing free radical cascade injures the ciliated epithelium. These events, together with the detritus in the sinuses, result in a decreased synthesis and increased absorption of nitric oxide in chronic sinus disease. To test these hypotheses, sinus mucosa will be studied from control and chronic sinusitis patients undergoing elective surgery. Catheritization of the maxillary sinus and the introduction of various concentrations of NO at varying flow rates will allow a determination of the rates of nitric oxide production and absorption in situ, Further, the determination of ciliary beat frequency during these
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procedures (using a specially designed laser Doppler probe) will demonstrate the relationship between ciliary function and NO concentrations. In vitro studies of sinus mucosa and sinus lavage fluids, using tonometry, NO metabolite analysis and enzymology, will further characterize these processes. Immunohistochemical staining of resected sinus tissues and archival tissue paraffin blocks will allow an identification of the NOS isoforms and their distribution in healthy and diseased tissues as well as the amounts and properties of the enzymes (Western blots, Elisa assay and enzymatic techniques using highly specific NOS antagonists). In addition, the techniques previously described will be used to determine nitro tyrosine resides, nitrosylated proteins and markers of apoptosis. CDNA array analysis for 400 cell related RNAs will give further insights into the pathogenesis of chronic sinusitis and results from these assays will suggest which specific cell signaling agents need further quantification by ELISA. Animal studies suggest a relationship between NO-induced cell injury and immunecomplex/ autoimmune diseases. Understanding these processes in the human sinus promises to provide new seminal information that could result in new therapy, better management and even prevention of chronic sinus disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pediatric EBM-Getting Evidence Used at the Point of Care Principal Investigator & Institution: Davis, Robert L.; Associate Professor; Pediatrics; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 1-AUG2003 Summary: The applicant plans to study the provision of evidence at the point of pediatric care, in order to increase the application of evidencebased medicine, change physician behavior, and expedite the translation of research into clinical practice. There will be two main questions. First, that use of an evidence-based decision support system at the point of care will improve antibiotic use in specific index pediatric outpatient diseases, and will (i) reduce frequency and duration of antibiotic therapy for otitis media, (ii) reduce duration of therapy for acute sinusitis, (iii) reduce use of bronchodialators in outpatient treatment of bronchiolitis, and (iv) increase use of intranasal steroids for allergic rhinitis. Second, that individualized physician feedback will provide additional benefit, when used in conjunction with the support system. This study will be carried out through a series of randomized controlled trials, implemented at three sites, including academic pediatric and family medicine health care
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centers, rural and suburban pediatric clinics, and a regional pediatric emergency department. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: SB-265805 Compared with Cefuroxime Axetil in Acute Sinus Principal Investigator & Institution: Friedman, Harvey M.; ; University of Pennsylvania 3451 Walnut Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 1-OCT-1974; Project End 0-NOV2002 Summary: Monitoring antibiotic resistance levels in the past few years have revealed a trend towards high degrees of bata-laetam resistance in the pathogens commonly associated with ABS (acute bacterial sinusitis). As a result, non-beta-lactam antibacterials must be considered for treatment of infections such as ABS as the efficacy of therapy with betalactam antibiotics, such as the penicillins and cepalosporins may be compromised. SB-265805 is a new quinolone antibacterial agent which represents an advantage amount fluoroquinolones. The primary objective is to demonstrate that the clinical efficacy at follow up of oral SB-265805 320mg once daily for seven days is at least as good as oral cefuroxime axetil 250mg twice daily for ten days in the treatment of ABS infections. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “sinusitis” (or synonyms) into the search box. This search gives you access to
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
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full-text articles. The following is a sample of items found for sinusitis in the PubMed Central database: ·
Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis by Sarah D de Ferranti, John P A Ioannidis, Joseph Lau, William V Anninger, and Michael Barza; 1998 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28657
·
Detection of Galactomannan for Diagnosis of Fungal Rhinosinusitis by Catherine Kauffmann-Lacroix, Marie-Helene Rodier, Jean-Louis Jacquemin, Jean Michel Goujon, and Jean-Michel Klossek; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88599&ren dertype=external
·
Invasive Fungal Sinusitis and Meningitis Due to Arthrographis kalrae in a Patient with AIDS by Peter V. Chin-Hong, Deanna A. Sutton, Marguerite Roemer, Mark A. Jacobson, and Judith A. Aberg; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87827&ren dertype=external
·
Lactoferrin and Eosinophilic Cationic Protein in Nasal Secretions of Patients with Experimental Rhinovirus Colds, Natural Colds, and Presumed Acute Community-Acquired Bacterial Sinusitis by Mark D. Niehaus, Jack M. Gwaltney, Jr., J. Owen Hendley, Mercy J. Newman, Peter W. Heymann, Gary P. Rakes, Thomas A. E. Platts-Mills, and Richard L. Guerrant; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87198&ren dertype=external
·
Maxillary Sinusitis Caused by Actinomucor elegans by Graciela Davel, Patricia Featherston, Anibal Fernandez, Ruben Abrantes, Cristina Canteros, Laura Rodero, Carlos Sztern, and Diego Perrotta; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87809&ren dertype=external
·
Maxillary Sinusitis Caused by Medusoid Form of Schizophyllum commune by Lynne Sigler, James R. Bartley, Dinah H. Parr, and Arthur J. Morris; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85581&ren dertype=external
·
Metarrhizium anisopliae as a Cause of Sinusitis in Immunocompetent Hosts by Sanjay G. Revankar, Deanna A. Sutton, Stephen E. Sanche,
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Jyothi Rao, Marcus Zervos, Farnaz Dashti, and Michael G. Rinaldi; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84204&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with sinusitis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “sinusitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “sinusitis” (hyperlinks lead to article summaries): ·
A comparative study of two treatment schemes in clinical sinusitis. Author(s): Kloosman WL. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1972 May 27; 46(22): 695-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4403494&dopt=Abstract
·
Complementary therapeutic practices in patients with chronic sinusitis. Author(s): Krouse HJ, Krouse JH. Source: Clin Excell Nurse Pract. 1999 November; 3(6): 346-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10865572&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
22
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·
Meningitis and spinal subdural empyema as a complication of sinusitis. Author(s): Harries-Jones R, Hernandez-Bronchud M, Anslow P, Davies CJ. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1990 May; 53(5): 441. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1972183&dopt=Abstract
·
Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches. Author(s): Folweiler DS, Lynch OT. Source: Journal of Manipulative and Physiological Therapeutics. 1995 January; 18(1): 38-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7706959&dopt=Abstract
·
Sinusitis in children: the importance of diagnosis and treatment. Author(s): Shrum KM, Grogg SE, Barton P, Shaw HH, Dyer RR. Source: J Am Osteopath Assoc. 2001 May; 101(5 Suppl): S8-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11409262&dopt=Abstract
·
Sinusitis: all stuffed up and nowhere to go. Author(s): Hillson G. Source: Gmhc Treat Issues. 2001 February-March; 15(2-3): 10-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11682802&dopt=Abstract
·
The effects of treatment with antibiotics, laser and acupuncture upon chronic maxillary sinusitis in children. Author(s): Pothman R, Yeh HL. Source: Am J Chin Med. 1982; 10(1-4): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7183207&dopt=Abstract
Vocabulary Builder Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce
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general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Anosmia: Absence of the sense of smell; called also anosphrasia and olfactory anaesthesia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Aspiration: The act of inhaling. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Bronchiolitis: Inflammation of the bronchioles. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU]
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Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU]
Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empyema: Accumulation of pus in a cavity of the body; when used without a descriptive qualifier, it refers to thoracic empyema (q.v.). [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Eosinophilia: The formation and accumulation of an abnormally large number of eosinophils in the blood. [EU] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes
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such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersecretion: Excessive secretion. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Lacrimal: Pertaining to the tears. [EU] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Molecular: Of, pertaining to, or composed of molecules : a very small mass
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of matter. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neutrophil: Having an affinity for neutral dyes. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical anti-inflammatory. It is also commonly used as an embedding material in histology. [NIH] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perennial: Lasting through the year of for several years. [EU] Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Receptor:
1. a molecular structure within a cell or on the surface
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characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reflux: A backward or return flow. [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Rhinovirus: A genus of picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Schizophyllum: A genus of fleshy shelf basidiomycetous fungi, family Schizophyllaceae, order aphyllophorales, growing on woody substrata. It is pathogenic in humans. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spirometry: Measurement of volume of air inhaled or exhaled by the lung.
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[NIH]
Sputum: Matter ejected from the lungs, bronchi, and trachea, through the mouth. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Sulfisoxazole: One of the antibacterial sulfonamides generally used for treatment of infections. It is bacteriostatic against a wide range of gramnegative and gram-positive organisms, but acquired resistance is common. [NIH]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]
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CHAPTER 5. PATENTS ON SINUSITIS Overview You can learn about innovations relating to sinusitis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with sinusitis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with sinusitis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Sinusitis By performing a patent search focusing on sinusitis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on sinusitis: ·
Methods and compositions for treating sinusitis, otitis media and other related disorders using antihistamines Inventor(s): Harris; Alan G. (New York, NY), Iezzoni; Domenic G. (Ridgewood, NJ), Danzig; Melvyn R. (Morganville, NJ), Lorber; Richard R. (Scotch Plains, NJ), Harris; Alan G. (New York, NY), Iezzoni; Domenic G. (Ridgewood, NJ), Danzig; Melvyn R. (Morganville, NJ), Lorber; Richard R. (Scotch Plains, NJ) Assignee(s): Schering Corporation Corporation (Kenilworth, NJ)
(Kenilworth,
NJ),
Schering
Patent Number: 6,423,721 Date filed: September 9, 1999 Abstract: The present invention discloses antibiotic-excluded compositions and methods to treat non-infective sinusitis and/or otitis media. The compositions comprise a therapeutically effective amount of an anticholinergic antihistamine or a pharmaceutically acceptable salt or solvate thereof; and (ii) a pharmaceutically acceptable carrier, and the methods comprise administering the same. Excerpt(s): The present invention generally relates to methods of treatment of sinusitis and otitis media (including otitis media with effusion and persistent middle ear effusion) involving the administration of a therapeutically effective amount of an antihistamine. It specifically relates to such treatment involving the administration of a therapeutically effective amount of loratadine or its metabolic derivative known as descarboethoxyloratadine (also referred to as desloratadine or "DCL"). The invention disclosed herein is related to that disclosed in pending U.S. Patent application, Serial No. 60/068,638, filed Dec. 23, 1997. ... The present invention generally relates to methods of treatment of sinusitis and otitis media (including otitis media with effusion and persistent
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middle ear effusion) involving the administration of a therapeutically effective amount of an antihistamine. It specifically relates to such treatment involving the administration of a therapeutically effective amount of loratadine or its metabolic derivative known as descarboethoxyloratadine (also referred to as desloratadine or "DCL"). The invention disclosed herein is related to that disclosed in pending U.S. Patent application, Serial No. 60/068,638, filed Dec. 23, 1997. ... Sinusitis is the most frequently reported chronic disease in the United States, affecting more than 14% of the population. Sinusitis is an inflammation of the mucosa of the paranasal sinuses. Generally, there is an allergic cause to sinusitis. Otitis media, like sinusitis, is also generally considered to have an allergic cause. These are also characterized by retention of thickened respiratory secretions; however, the inflammation is manifest in the ear rather than in the sinuses. A discussion of sinusitis and otitis media can be found in Conn's Current Therapy, 235 (1997); Diseases of the Sinuses--A Comprehensive Textbook of Diagnosis and Treatment, ed. M. E. Gershwin et al, Human Press, Totowa, N.J., pages 151-157 (1996); and Allergy-Principles and Practice, Volume II, ed. E. Middleton, Jr. et al, Mosby-Year Book, Inc., New York, pages 1027-1033 (1998). Also, a review of sinusitis and related facts is given by Z. Pelikan, "The Role of Allergy in Sinus Disease", Clinical Reviews in Allergy and Immunology 16, 55156 (1998). ... Sinusitis is the most frequently reported chronic disease in the United States, affecting more than 14% of the population. Sinusitis is an inflammation of the mucosa of the paranasal sinuses. Generally, there is an allergic cause to sinusitis. Otitis media, like sinusitis, is also generally considered to have an allergic cause. These are also characterized by retention of thickened respiratory secretions; however, the inflammation is manifest in the ear rather than in the sinuses. A discussion of sinusitis and otitis media can be found in Conn's Current Therapy, 235 (1997); Diseases of the Sinuses--A Comprehensive Textbook of Diagnosis and Treatment, ed. M. E. Gershwin et al, Human Press, Totowa, N.J., pages 151-157 (1996); and Allergy-Principles and Practice, Volume II, ed. E. Middleton, Jr. et al, Mosby-Year Book, Inc., New York, pages 1027-1033 (1998). Also, a review of sinusitis and related facts is given by Z. Pelikan, "The Role of Allergy in Sinus Disease", Clinical Reviews in Allergy and Immunology 16, 55-156 (1998). ... Sinusitis and otitis media are often typically treated as an infectious disease. The treatment typically includes administration of an antibiotic along with a corticosteroid and an antihistamine, or a nasal decongestant, such as described in, for example, J. Braun et al, Allergy, 52 (6), 650-655 (1997). There are, however, occasions, when the sinusitis or otitis media is not necessarily accompanied by an infection. This is particularly true when the disease is associated with allergic rhinitis. At those times,
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administration of an antibiotic may not be needed. Physicians, however, do not generally administer antihistamines for these indications without accompanying antibiotic. This has been so since earlier known antihistamines, among other things, were anticholinergic, drying nasal secretions. Although antihistamines with far less anticholinergic activity are now available, no attempt to treat sinusitis or otitis media with administration of substantially non-sedating antihistamine with nonanticholinergic or reduced anticholinergic activity and without accompanying antibiotics has been reported. ... Sinusitis and otitis media are often typically treated as an infectious disease. The treatment typically includes administration of an antibiotic along with a corticosteroid and an antihistamine, or a nasal decongestant, such as described in, for example, J. Braun et al, Allergy, 52 (6), 650-655 (1997). There are, however, occasions, when the sinusitis or otitis media is not necessarily accompanied by an infection. This is particularly true when the disease is associated with allergic rhinitis. At those times, administration of an antibiotic may not be needed. Physicians, however, do not generally administer antihistamines for these indications without accompanying antibiotic. This has been so since earlier known antihistamines, among other things, were anticholinergic, drying nasal secretions. Although antihistamines with far less anticholinergic activity are now available, no attempt to treat sinusitis or otitis media with administration of substantially non-sedating antihistamine with nonanticholinergic or reduced anticholinergic activity and without accompanying antibiotics has been reported. Web site: http://www.delphion.com/details?pn=US06423721__ ·
Method of treating rhinitis or sinusitis by intranasally administering a peptidase Inventor(s): Grouzmann; Eric (La Conversion, CH), Lacroix; Jean-Silvain (Geneva, CH), Monod; Michel (Lausanne, CH) Assignee(s): B.M.R.A. Corporation B.V. (Rotterdam, NL) Patent Number: 6,337,069 Date filed: February 28, 2001 Abstract: The present invention is directed to methods of treating mucosal inflammation associated with rhinitis or sinusitis by administering peptidases that recognize and cleave polypeptides at XaaPro sequences. In addition, the invention encompasses therapeutic packages in which pharmaceutical compositions containing the
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peptidases are preloaded in a device suitable for intranasally delivering drug. Excerpt(s): The present invention is directed to methods of treating inflammation associated with rhinitis or sinusitis by intranasally delivering peptidases to a patient. The invention also encompasses therapeutic packages in which a peptidase is preloaded in a device designed for intranasally delivering drug. ... Rhinitis, an inflammation of the nasal mucosal membrane, is characterized by sneezing, rhinorrhea, nasal congestion, and increased nasal secretion. It is often accompanied by sinusitis, an inflammation of the sinuses. When these conditions persist for a period of more than three weeks, they are termed "chronic." More than 37 million Americans, particularly those with allergies or asthma, suffer from these conditions, making them the most common chronic medical problems in the United States. ... Chronic "rhinosinusitis" or sinusitis is difficult to treat successfully. In general, treatment consists of a combination of antibiotics and decongestants or antihistamines. In addition, steroid nasal sprays are commonly used to reduce inflammation. For patients with severe chronic sinusitis, oral steroids, such as prednisone, may also be prescribed. However, the long-term safety of steroid administration, especially in children, is not fully understood and oral steroids often have significant side effects. When drug therapy fails, surgery is usually the only alternative. Web site: http://www.delphion.com/details?pn=US06337069__ ·
Method and device for coordinating topical and oral sinusitis treatments Inventor(s): Weinstein; Robert E. (177 Commonwealth Ave., Boston, MA 02116), Weinstein; Allan M. (9205 Pegasus Ct., Potomac, MD 20854) Assignee(s): none reported Patent Number: 6,294,178 Date filed: November 1, 1999 Abstract: A sinusitis treatment system having an oral dosage constituent, a topical nasal dosage constituent, indicia and instructions for administration of the oral dosage constituent and the topical nasal dosage constituent as an at least ten-day sinusitis treatment regimen. Excerpt(s): The present invention relates to a method and device for organizing and coordinating combined aerosol and oral medications for treating sinusitis. ... While the market place abounds with pill boxes and organizers for oral medications and while an organizational tool is
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presently available for a lay person to organize topical medications with oral medications, none of the prior art specifically claims a system for treating sinusitis. ... Therefore, what is needed is a device that combines topical and oral modalities of treatment for sinusitis. What is further needed is a method for enhancing compliance of combined therapeutic regimens for treatment of sinusitis. Web site: http://www.delphion.com/details?pn=US06294178__ ·
Calcium mupirocin non-aqueous nasal spray for otitis media or for recurrent acute bacterial sinusitis Inventor(s): Hatton; Anthony Guy (Worthing, GB), Scott; Hugh (Bishop's Stortford, GB), Hilton; Jane Elizabeth (Bishop's Stortford, GB) Assignee(s): Smithkline Beecham Corporation (Philadelphia, PA) Patent Number: 6,156,792 Date filed: September 29, 1999 Abstract: Mupirocin or a salt or ester thereof may be used to treat recurrent sinusitis and recurrent otitis, in particular with novel spray or cream formulations adapted for administration to the nasopharynx Excerpt(s): The present invention relates to the use of mupirocin or a salt or ester thereof in treating certain bacterial infections, in particular recurrent otitis media and recurrent sinusitis, and to formulations for use in such treatment. ... A further potential therapeutic use of mupirocin has been described by Nsouli et al (poster presented at the Annual Meeting of the American College of Allergy, Asthma and Immunology, Nov. 10--15, 1995 and published in Annals of Allergy, Asthma and Immunology, January 1996, 76(1), 117). A spray formulation comprising Bactroban Ointment diluted in a 1:9 ratio with a saline solution (Ocean, Fleming & Co) was shown to be effective in reducing the incidence of recurrent paranasal sinusitis when administered twice daily (two `puffs` of spray, estimated to be about 150-200.mu.l) over a seven month period. It is believed that efficacy of the mupirocin/saline combination is the result of eradication of nasal carriage of pathogenic bacteria associated with the recurrent episodes as the formulation would have no direct access to the sinus mucosa due to a small ostium which separates the nasopharynx from the maxillary sinuses. This dosage regimen may however not be ideal as there is concern that the use of a relatively low dosage over a prolonged period may encourage the development of mupirocin resistant bacteria. Furthermore, there may also be concerns about the desirability of the long term usage of aqueous solutions of mupirocin, given the known susceptibility of mupirocin to degradation in such an
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environment. There still remains the problem of providing a method of treatment for recurrent sinusitis which is devoid of the concerns mentioned above. In addition, there was no suggestion of other diseases which might be susceptible to similar treatment. ... Accordingly, in a first aspect, the present invention provides for the use of mupirocin or a pharmaceutically acceptable ester or salt thereof in the manufacture of a medicament for the prophylactic treatment of bacterial infection associated with colonisation of the nasopharyrx by pathogenic organisms, and in which the medicament is adapted for administration to, and residence within, the nasopharyrlx; excluding the use of a 0.2% saline solution of mupirocin for treating recurrent sinusitis, administered at a dosage of less than 1 mg a day, twice daily on a continuing basis. Web site: http://www.delphion.com/details?pn=US06156792__ ·
Medical instrument for treating sinusitis Inventor(s): Miyagi; Kunihiko (Tokyo,, JP), Yoshizawa; Hidetoshi (Tokyo,, JP) Assignee(s): Machida Endoscope Co., Ltd. (Tokyo, JP) Patent Number: 5,496,338 Date filed: June 16, 1994 Abstract: A medical instrument for treating sinusitis has a body, an insert tube extending from a distal end of the body, and an angle portion extending from a distal end of the insert tube. The angle portion is bent by a remote control member mounted on the body, through a wire. A motor is mounted on the body. The medical instrument also has a brush. This brush has an elongated rotation transmission portion extending through the insert tube and the angle tube, and a brush portion attached to a distal end of the rotation transmission portion. A basal portion of the rotation transmission portion is connected to the motor. The brush portion is allowed to protect from a distal end of the angle tube. At least that portion of the rotation transmission portion extending through the angle tube is bendable. Therefore, when the motor is rotated in the state that the angle portion is bent, the brush portion is rotated. Excerpt(s): This invention relates to a medical instrument for treating inflammation of the paranasal sinus, i.e., sinusitis. ... Sinusitis, for example, maxillary sinusitis, is a disease in which a mucous membrane on an inner surface of the maxillary sinus is inflamed or peeled and finally suppurated to produce pus. As one method for treating the maxillary sinus, there is known a method, in which the peeled mucous membrane is removed by an elongated spatula and drawn or sucked by a
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drawing instrument or suction apparatus. ... It is therefore an object of the present invention to provide a medical instrument which is capable of remarkably improving the effect of treatment of sinusitis. Web site: http://www.delphion.com/details?pn=US05496338__ ·
Method of draining the maxillary sinus for the treatment of maxillary sinusitis Inventor(s): Spits; Marc (Achel, BE) Assignee(s): Fundatech S.A. (CH) Patent Number: 4,737,141 Date filed: December 12, 1985 Abstract: Maxillary sinusitis is treated by placing a self-supporting temporary drain hose in a wall separating the sinus and a nasal cavity. The hose allows drainage from the sinus, and repeated rinsings without the need of further operations. Between rinsings, air enters the sinus through the hose and kills bacteria therein. Excerpt(s): Maxillary sinusitis has been generally treated with repeated so-called classical antral lavages. These classical antral lavages are painful for the patient, and unpleasant and time-consuming for the doctor. The antral lavages are frequently followed by the administration of various drugs. If the condition becomes chronic, a Claue operation or a CaldwallLuc operation is also performed. ... The treatment of the maxillary sinusitis with classical antral lavages thus means for the patient at least on the average five, painful, unpleasant and time-consuming treatments and for the physician at least on the average five unpleasant and timeconsuming treatments of the patient. ... In view of the above, it is a principal objective of the present invention to provide a method of treating maxillary sinusitis which requires a single operation regardless of the length of time necessary for the sinus to heal. Web site: http://www.delphion.com/details?pn=US04737141__
Patent Applications on Sinusitis As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to
24
This has been a common practice outside the United States prior to December 2000.
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achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to sinusitis: ·
Aerosolized anti-infectives, anti-inflammatories, and decongestants for the treatment of sinusitis Inventor(s): Osbakken, Robert S. ; (Camarillo, CA), Hale, Mary Anne ; (Woodland Hills, CA), Leivo, Frederick T. ; (Carpinteria, CA), Munk, James D. ; (Camarillo, CA) Correspondence: MORGAN, LEWIS & BOCKIUS; 1800 M STREET NW; WASHINGTON; DC; 20036-5869; US Patent Application Number: 20020061281 Date filed: August 31, 2001 Abstract: Pharmaceutical compositions are described that comprise one or more active ingredients selected from the group consisting of an antiinfective agent, anti-inflammatory agent, anti-mucolytic agent, antihistamine, an antiseptic, and antibiotic combinations or combinations of others of these classes of ingredients, and particularly to compositions formulated as a solution or suspension in a unit dose for aerosol administration to treat chronic sinusitis. Excerpt(s): The present invention relates to pharmaceutical compositions comprising one or more active ingredients selected from the group consisting of anti-infective agents, anti-inflammatory agents, mucolytic agents, antihistamines, antileukotrienes, decongestants, anticholinergics and antiseptics and particularly to compositions formulated into a liquid, for example, as a solution, suspension, or emulsion, in a unit dose or multi-dose vials for aerosol administration to treat chronic sinusitis. ... A number of factors and/or processes are involved in maintaining healthy sinuses. The mucus secreted by the membrane lining must be fluid but sticky, in order to flow freely yet absorb pollutants and entrap bacteria. It must also contain sufficient amounts of bacteria-fighting substances, such as antibodies. Additionally, small hair-like projections called cilia, located in the nostril, must beat in unison to propel mucus outward, in order to expel bacteria and other particles. Moreover, the mucous membranes themselves must be intact, and the sinus passages must be open to allow drainage and the circulation of air through the nasal passage. When one or more of these processes or factors are amiss, causing obstruction of the sinus passage, an infection called sinusitis develops. ... Sinusitis is an inflammation of the membrane lining one or more paranasal sinuses. There are three different types of sinusitis: acute, recurrent acute, and chronic. As an example, acute bacterial sinusitis is characterized as lasting less than three weeks or occurring less than four times a year and
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can be successfully treated using antibiotics, leaving no damage to the linings of the sinus tissue. Recurrent acute sinusitis occurs more often but leaves no significant damage. Chronic sinusitis lasts longer than three weeks and often continues for months. In cases of chronic sinusitis, there is usually tissue damage. According to the Center for Disease Control (CDC), thirty seven million cases of chronic sinusitis are reported annually. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Composition and method for the treatment of sinusitis Inventor(s): Nicolay, Phil Arnold ; (Dewitt, MI) Correspondence: POWELL GOLDSTEIN FRAZER; & MURPHY LLP; 1001 Pennsylvania Avenue 6th Floor; Washington; DC; 20004; US Patent Application Number: 20020018771 Date filed: May 26, 2000 Abstract: A composition and method for the treatment of chronic sinusitis in which a composition containing "friendly" colonial bacteria is applied externally in the form of either a spray or a flush. The bacteria are selected from the genus Lactobacillus and the genus Bifidobacterium. The selected bacteria are provided in a therapeutically effective amount in a water solution. Excerpt(s): The present invention relates generally to ailments of the sinuses in humans. More particularly, the present invention pertains to a composition and method for the treatment of sinusitis in humans. The composition includes the bacteria Lactobacillus acidophilus as an antifungal agent in distilled water as a carrier. ... In their ordinary and healthy condition, the sinuses allow for the free passage of air and the equalization of air pressure. Mucous fluid flows from the sinuses and drains into the nose. However, when the passageways are obstructed, fluid cannot pass freely through the sinuses, and the sinus cavities fill with fluid and are blocked. Symptoms of sinus blockage include coughing, facial pressure, congestion, and fatigue. Sufferers of sinusitis frequently confuse sinusitis for another ailment, such as a cold, a flu, or a sore throat. ... Blockage of the sinuses is typically the result of inflammation of the sinus cavities. This inflammation, known as "sinusitis," is the result of undrained mucous in one or more of the sinus cavities. There are a variety of causes of sinus inflammation, although the typical causes include the presence of fungi, bacterial and viral infection, or allergens. Other causes include obstructions due to deviated septum and nasal polyps which form in the nasal passages and which obstruct
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breathing. Regardless of the cause, inflammation of the sinus cavities causes the swelling and congestion of membranes associated with the sinuses. Pain results from the congestion and mucous production increases and the mucous itself becomes thicker. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with sinusitis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “sinusitis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on sinusitis. You can also use this procedure to view pending patent applications concerning sinusitis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Aqueous: Watery; prepared with water. [EU] Bifidobacterium: A rod-shaped, gram-positive, non-acid-fast, non-sporeforming, non-motile bacterium that is a genus of the family
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actinomycetaceae. It inhabits the intestines and feces of humans as well as the human vagina. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Loratadine: A second-generation histamine H1 receptor antagonist used in the treatment of allergic rhinitis and urticaria. Unlike most classical antihistamines it lacks central nervous system depressing effects such as drowsiness. [NIH] Medicament: A medicinal substance or agent. [EU] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Rhinorrhea: The free discharge of a thin nasal mucus. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU]
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CHAPTER 6. BOOKS ON SINUSITIS Overview This chapter provides bibliographic book references relating to sinusitis. You have many options to locate books on sinusitis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on sinusitis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “sinusitis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on sinusitis:
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·
Beyond Antibiotics: 50 (Or So) Ways to Boost Immunity and Avoid Antibiotics Contact: North Atlantic Books, PO Box 12327, Berkeley, CA, 94701-9998, (510) 559-8277. Summary: This monograph examines the reported overuse of antibiotics in medicine and the problems caused by the creation of antibioticresistant bacteria. The authors, physicians who describe themselves as holistic doctors, propose minimizing the use of antibiotics through enhancing health, boosting resistance to illness, and using preventive strategies. They analyze evidence indicating that diet, nutrition, lifestyle, environment, and stress have an important impact on resistance to infection. A section on natural medicine explores the use of vitamins, herbal medicine, homeopathy, and other natural methods for strengthening immunity. The final section offers "selfcare" and "wellcare" alternatives for treating conditions for which antibiotics are usually prescribed, such as fever, vaginitis, sinusitis, and intestinal infections with diarrhea.
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Ear, Nose, and Throat Disorders Sourcebook Source: Detroit, MI: Omnigraphics, Inc. 1998. 576 p. Contact: Available from Omnigraphics, Inc. Penobscot Building, Detroit, MI 48226. (800) 234-1340. Fax (800) 875-1340. PRICE: $78.00. ISBN: 0780802063. Summary: This reference book provides information about some of the most common disorders of the ears, nose, and throat. The text describes diseases and their accompanying symptoms, as well as treatment options and current research initiatives. The book's 67 chapters are arranged in six parts: introduction, disorders of the inner and outer ear, vestibular disorders, disorders of the nose and sinuses, disorders of the throat, and cancers related to the ears, nose, and throat. Specific disorders and topics include otitis externa, otitis media, allergy, perforated eardrum, cholesteatoma, otosclerosis, tinnitus, hyperacusis, ear surgery, dizziness, BPPV (benign paraoxysmal positional vertigo), labyrinthitis, Meniere's disease, perilymph fistula, sinusitis, rhinitis, antihistamines, nosebleeds, smell and taste problems, sore throats, hoarseness, swallowing disorders, salivary glands, snoring, sleep apnea, spasmodic dysphonia, laryngeal diseases and disorders, smoking cessation, head and neck cancer, cancer of the oral cavity and upper throat, esophageal cancer, and oropharyngeal cancer. Simple line drawings illustrate some of the anatomical concepts discussed. The book also includes a glossary of
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terms and an annotated directory of organizational resources with addresses, telephone numbers, e-mail addresses, and web site locations. ·
ENT Secrets: Questions You Will Be Asked On Rounds, In the Clinic, In the OR, On Exams Source: Philadelphia, PA: Hanley and Belfus. 1996. 480 p. Contact: Available from Hanley and Belfus. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (800) 962-1892 or (215) 5467293; Fax (215) 790-9330; http://www.hanleyandbelfus.com. PRICE: $35.95 plus shipping and handling. ISBN: 1560531592. Summary: This book utilizes a question and answer format to review details of the specialty of otorhinolaryngology (ear, nose and throat, or ENT). In addition to explicating details and specifics, professional training should refine the student's ability to formulate the appropriate questions to ask when making medical decisions. Eighty-five chapters are categorized in the following sections: otology, the nose and sinuses, general otolaryngology, endoscopy, tumors, facial plastic surgery, trauma and emergencies, pediatric otolaryngology, related specialties, and critical care issues. Specific topics include the anatomy and physiology of the ear, hearing evaluations, types of hearing loss, otitis media, evaluation of the dizzy patient, vestibular disorders, tinnitus, anatomy and physiology of the nose, rhinitis, sinus anatomy and function, sinusitis, temporomandibular joint disease, oral lesions, facial nerve disorders, esophageal disorders, salivary gland disorders, hoarseness, otolaryngologic manifestations of AIDS, salivary gland tumors, tumors of the nose and paranasal sinuses, laryngeal cancer, head and neck cancer, rhinoplasty, principles of grafts and flaps, principles of skin resurfacing, otoplasty, epistaxis (nosebleed), nasal trauma, upper airway obstruction, tonsils and adenoids, congenital malformations, cleft lip and palate, taste and smell disorders, allergy and immunology, nutritional assessment and therapy, and tracheotomy. Each chapter include line drawing illustrations and references; a subject index concludes the volume.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently
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listed with online booksellers as relating to sinusitis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Childhood Rhinitis and Sinusitis: Pathophysiology and Treatment (Allergic Disease and Therapy, No 3) by Charles K. Naspitz, David G. Tinkelman (Editor); ISBN: 0824782283; http://www.amazon.com/exec/obidos/ASIN/0824782283/icongroupin terna
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Complications of Acute and Chronic Sinus Disease (Continuing Education Program (American Academy of Otolaryngology--Head and Neck Surgery Foundation). by Berrylin J. Ferguson (Editor), American Academy of Otolaryngology--Head (1999); ISBN: 1567720749; http://www.amazon.com/exec/obidos/ASIN/1567720749/icongroupin terna
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Contemporary Diagnosis and Management of Sinusitis by George A. Pankey, et al; ISBN: 1884065694; http://www.amazon.com/exec/obidos/ASIN/1884065694/icongroupin terna
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Diagnosis and Management of Rhinitis and Sinusitis (2nd Edition) by Mani S. Kavuru, et al; ISBN: 1884735495; http://www.amazon.com/exec/obidos/ASIN/1884735495/icongroupin terna
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Diets to help hay fever and sinusitis by Roger Newman Turner; ISBN: 0722501587; http://www.amazon.com/exec/obidos/ASIN/0722501587/icongroupin terna
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Easy Breathing: Natural Treatments For Asthma, Colds, Flu, Coughs, Allergies & Sinusitis by David Hoffmann; ISBN: 1580172520; http://www.amazon.com/exec/obidos/ASIN/1580172520/icongroupin terna
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Fact/Book on Sinusitis, Bronchitis and Emphysema and Their Natural Treatment by Clifford Quick; ISBN: 9995344300; http://www.amazon.com/exec/obidos/ASIN/9995344300/icongroupin terna
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Herbs to Help You Breathe Freely: Herbal Remedies for Asthma, Allergies, Sinusitis and Other Respiratory Problems (Good Herb Guides) by C. J. Puotinen (1996); ISBN: 0879837411; http://www.amazon.com/exec/obidos/ASIN/0879837411/icongroupin terna
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Living With Chronic Sinusitis: A Patient's Guide to Sinusitis, Nasal Allergies, Polyps and Their Treatment Options by David W. Kennedy
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(2002); ISBN: 1578261031; http://www.amazon.com/exec/obidos/ASIN/1578261031/icongroupin terna ·
MarketLooks: The U.S. Market for Over-the-Counter Sinusitis Remedies [DOWNLOAD: PDF] by MarketLooks - Kalorama Information (Author); ISBN: B00005U85W; http://www.amazon.com/exec/obidos/ASIN/B00005U85W/icongroup interna
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Nasal Manifestations of Systemic Diseases by Michael Schatz, et al (1991); ISBN: 0936587032; http://www.amazon.com/exec/obidos/ASIN/0936587032/icongroupin terna
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Nature cure for sinusitis by Clifford Quick; ISBN: 0722502591; http://www.amazon.com/exec/obidos/ASIN/0722502591/icongroupin terna
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Otitis Media and Sinusitis by Russell W. Steele; ISBN: 1581110383; http://www.amazon.com/exec/obidos/ASIN/1581110383/icongroupin terna
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Pediatric Sinusitis by Rodney P. Lusk (Editor); ISBN: 0881678945; http://www.amazon.com/exec/obidos/ASIN/0881678945/icongroupin terna
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Relief from Chronic Sinusitis (The Dell Medical Library) by Marilynn Larkin; ISBN: 0440213614; http://www.amazon.com/exec/obidos/ASIN/0440213614/icongroupin terna
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Sinus Survival by Robert S. Ivker, Eileen Rudnick (Illustrator) (1992); ISBN: 0962184500; http://www.amazon.com/exec/obidos/ASIN/0962184500/icongroupin terna
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Sinus Survival: A Self-Help Guide for Allergies, Bronchitis, Colds, and Sinusitis by Robert S., Dr. Ivker, Gilbert W. Levitt; ISBN: 0874776848; http://www.amazon.com/exec/obidos/ASIN/0874776848/icongroupin terna
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Sinus Survival: The Holistic Medical Treatment for Allergies, Asthma, Bronchitis, Colds, and Sinusitis by Robert S. Ivker (1995); ISBN: 0874778077; http://www.amazon.com/exec/obidos/ASIN/0874778077/icongroupin terna
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Sinus Survival: The Holistic Medical Treatment for Sinusitis, Allergies, and Colds by Robert S. Ivker; ISBN: 1585420581; http://www.amazon.com/exec/obidos/ASIN/1585420581/icongroupin terna
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Sinusitis Bronchitis by Clifford Quick; ISBN: 0879831189; http://www.amazon.com/exec/obidos/ASIN/0879831189/icongroupin terna
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Sinusitis Relief by Harvey Plasse, Shelagh Ryan Masline (2002); ISBN: 0805068058; http://www.amazon.com/exec/obidos/ASIN/0805068058/icongroupin terna
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Sinusitis: Pathophysiology and Treatment (Clinical Allergy and Immunology, Vol 1) by Howard M. Druce (Editor); ISBN: 0824788451; http://www.amazon.com/exec/obidos/ASIN/0824788451/icongroupin terna
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The Sinus Cure: 7 Simple Steps to Relieve Sinusitis and Other Ear, Nose, and Throat Conditions by Debra Fulghum Bruce, Murray Grossan; ISBN: 0345439716; http://www.amazon.com/exec/obidos/ASIN/0345439716/icongroupin terna
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The Sinus Handbook: A Self-Help Guide by Muriel K. MacFarlane, L. E. Mills (Illustrator) (1997); ISBN: 1887053085; http://www.amazon.com/exec/obidos/ASIN/1887053085/icongroupin terna
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The Sinus Sourcebook by Deborah F. Rosin (1999); ISBN: 0737300833; http://www.amazon.com/exec/obidos/ASIN/0737300833/icongroupin terna
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The Sinusitis Help Book: A Comprehensive Guide to a Common Problem: Questions, Answers, Options by M. Lee Williams (1998); ISBN: 0471347027; http://www.amazon.com/exec/obidos/ASIN/0471347027/icongroupin terna
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The Truth About Sinusitis by Charles P., M.D. Lebo; ISBN: 188068800X; http://www.amazon.com/exec/obidos/ASIN/188068800X/icongroupi nterna
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The Truth About Sinusitis: A Self-Care Guide for Nose and Sinus Problems by Charles P., M.D. Lebo; ISBN: 1880688018; http://www.amazon.com/exec/obidos/ASIN/1880688018/icongroupin terna
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Time-Life Alternative Remedies for Common Ailments: How to Treat, Arthritis, Back Problems, Chronic Fatigue, Headaches, Insomnia, Sinusitis-- And ove ; ISBN: 073701105X; http://www.amazon.com/exec/obidos/ASIN/073701105X/icongroupi nterna
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Use of Ciprofloxacin in the Treatment of Chronic Otitis and Sinusitis and Malignant External Otitis (Journal-Chemotherapy, 1994 , Vol 40, Supplement) by F. Legent (Editor) (1994); ISBN: 3805560710; http://www.amazon.com/exec/obidos/ASIN/3805560710/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “sinusitis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·
Childhood rhinitis and sinusitis: pathophysiology and treatment. Author: edited by Charles K. Naspitz, David G. Tinkelman; Year: 1990; New York: M. Dekker, c1990; ISBN: 0824782283 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824782283/icongroupin terna
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Chronic nasal sinusitis and its relation to general medicine (chronic sinusitis and systemic sepsis) by Patrick Watson-Williams ... with a foreword by Sir Humphry Davy Rolleston ... Author: Watson-Williams, Patrick, 1863-; Year: 1933; Bristol, J. Wright; sons ltd.; London, Simpkin, Marshall ltd., 1933
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Chronic nasal sinusitis and its relation to mental disorder; an applied pathology of abnormal conditions of the nasal sinuses found in mental hospital patients. Author: Pickworth, Frederick Alfred, 1889-; Year: 1935; London, Lewis, 1935
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Chronic respiratory disease and infectious sinusitis; annotated bibliography. Author: Merck & Company, inc; Year: 1956; Rahway, N. J., Merck; Co., inc., Chemical Division [c1956]
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Complications of acute and chronic sinus disease. Author: Berrylin J. Ferguson ... [et al.]; Year: 1999; Alexandria, VA: American Academy of Otolaryngology--Head and Neck Surgery Foundation, 1999; ISBN: 1567720749 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1567720749/icongroupin terna
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Contemporary diagnosis and management of sinusitis. Author: George A. Pankey, Charles W. Gross, Michael G. Mendelsohn; Year: 1997; Newtown, Pa., USA: Handbooks In Health Care, c1997; ISBN: 1884065430 (pbk.)
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Diagnosis and treatment of acute bacterial rhinosinusitis. Author: prepared by Joseph Lau, principal investigator; Year: 1999; [Rockville, MD]: AHCPR Publication, [1999]
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Diagnosis and treatment of uncomplicated acute sinusitis in children. Author: prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by New England Medical Center, Boston, MA; Joseph Lau, principal inves; Year: 2000; Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, [2000]; ISBN: 1587630206
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Diets to help hay fever and sinusitis. Author: Turner, R. Newman; Year: 1970; London, Thorsons [1970]; ISBN: 0722501587 http://www.amazon.com/exec/obidos/ASIN/0722501587/icongroupin terna
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Diseases of the sinuses: a comprehensive textbook of diagnosis and treatment. Author: edited by M. Eric Gershwin and Gary A. Incaudo; Year: 1996; Totowa, N.J.: Humana Press, c1996; ISBN: 0896033171 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0896033171/icongroupin terna
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Endoscopic surgery for mycotic and chronic recurring sinusitis. Author: Heinz Stammberger; Year: 1985; St. Louis, Mo. (4507 Laclede Ave., St. Louis 63108): Annals Pub. Co., c1985
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ENT allergy. Author: C. Warren Bierman, topic editor; Year: 1984; New York, N.Y.: Elsevier Science Pub. Co., c1984
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Functional and morphological studies on chronic sinusitis mucous membrane. Author: by Yoshihiro Ohashi ... [et al.]; Year: 1983; Stockholm, Sweden: Distributed by Almqvist; Wiksell Periodical Co., [1983]
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Health care guideline: acute sinusitis in adults. Author: Institute for Clinical Systems Improvement; Year: 2001; Bloomington, MN: ICSI, 2001
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Maxillary sinusitis: studies on antral gas environment, local immunity and effects of treatment. Author: by Christer Carenfelt; Year: 1977; Stockholm: [s.n.], 1977
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Nasal manifestations of systemic diseases. Author: edited by Michael Schatz, Robert S. Zeiger, Guy A. Settipane; Year: 1991; Providence, R.I.: OceanSide Publications, inc., 1991; ISBN: 0936587032 http://www.amazon.com/exec/obidos/ASIN/0936587032/icongroupin terna
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Nature cure for sinusitis. Author: Quick, Clifford; Year: 1974; Wellinborough, Eng., Thorsons [c1974]; ISBN: 0722502591 http://www.amazon.com/exec/obidos/ASIN/0722502591/icongroupin terna
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Paediatric maxillary sinusitis treated by antrostomy: a follow-up study in 103 children. Author: Pirkko Ruoppi; Year: 1986; Kuopio [Finland]: Dept. of Otolaryngology, University of Kuopio, 1986; ISBN: 9517802226 (pbk.)
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Pediatric rhinosinusitis. Author: Scott R. Schoem, Andrew M. Shapiro; Year: 2000; Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2000; ISBN: 1567720323 (pbk.: alk. paper)
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Pediatric sinusitis. Author: editor, Rodney P. Lusk; Year: 1992; New York: Raven Press, c1992; ISBN: 0881678945 http://www.amazon.com/exec/obidos/ASIN/0881678945/icongroupin terna
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Rhinitis: mechanisms and management. Author: edited by Ian Mackay; Year: 1989; London; New York: Royal Society of Medicine Services, c1989; ISBN: 0905958926
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Rhinosinusitis: current issues in diagnosis and management. Author: edited by Valerie Lund and Jacquelynne Corey; Year: 1999; London; Lake Forest, IL: Royal Society of Medicine Press, c1999; ISBN: 1853154199 http://www.amazon.com/exec/obidos/ASIN/1853154199/icongroupin terna
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Secret of sinusitis and headaches, by Dr. Lucius M. Bush. Author: Bush, Lucius M; Year: 1938; New York, Liveright publishing corporation [c1938]
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Sinusitis: pathophysiology and treatment. Author: edited by Howard M. Druce; Year: 1994; New York: Dekker, c1994; ISBN: 0824788451 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824788451/icongroupin terna
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Sinusitis. Author: Strothers, Gordon; Year: 1974; [Kansas City, Mo., American Academy of Family Physicians, c1974]
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So you have sinus trouble. Author: Winter, Ruth, 1930-; Year: 1973; New York, Grosset; Dunlap [c1973]; ISBN: 044811521
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Ultrasonic examination of the paranasal sinuses. Author: by Magnus Jannert ... [et al.]; Year: 1982; Malmö: [s.n.]; Stockholm, Sweden: Distributed by Almqvist; Wiksell Periodical Co., 1982
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Ultrasound in the diagnosis of maxillary and frontal sinusitis. Author: by Matti Revonta; Year: 1980; Turku: [s.n.]; Stockholm, Sweden: Distributed by the Almqvist; Wiksell Periodical Co., 1980
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What about - Tonsils and adenoids? Sinus trouble and asthma? Is asthma inherited? Can sinusitis and asthma be cured? By J. Thompson Stevens ... Author: Stevens, J. Thompson, 1890-; Year: 1942; New York, Educational publishing house, 1942
Chapters on Sinusitis Frequently, sinusitis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with sinusitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and sinusitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “sinusitis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on sinusitis:
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How Vocal Abilities Can Be Limited by Non-Infectious Diseases and Disorders of the Respiratory and Digestive Systems Source: in Thurman, L. and Welch, G., eds. Bodymind and Voice: Foundations of Voice Education, Volumes 1-3. 2nd ed. Collegeville, MN: VoiceCare Network. 2000. p. 546-555. Contact: Available from National Center for Voice and Speech (NCVS). Book Sales, 334 Speech and Hearing Center, University of Iowa, Iowa City, IA 52242. Website: www.ncvs.org. PRICE: $75.00 plus shipping and handling. ISBN: 0874141230. Summary: This chapter on noninfectious diseases and disorders of the respiratory and digestive systems is from a multi-volume text that brings a biopsychosocial approach to the study of the voice. The authors use the phrase 'bodyminds' to describe the interrelationship of perception, memory, learning, behavior, and health, as they combine to affect all environmental interactions, adaptations, and learning. The books are written for teachers, voice professionals, people who use their voices on an avocational basis, and interested members of the general public. This chapter describes the effects of smoking and other pollutants, sinusitis and rhinitis, laryngitis, bronchitis and other pulmonary (lung) diseases, the effects of outdoor and indoor air pollution, normal and disordered nasal (nose) conditions, asthma, obstructive sleep apnea, emphysema, and gastroesophageal reflux disease (GERD, the return of stomach acid to the esophagus and larynx). GERD can result in hoarseness, lowering of the average speaking pitch range, increased effort when singing, and a 'tired voice.' Asthma can affect voice primarily by decreasing the ability of the respiratory system to inhale and then pressurize the lung air to create sufficient breathflow between the vocal folds. Asthma symptoms can be triggered by inhalation of allergens or pollutant particles of irritant chemicals, infection, cold air, vigorous exercise, acute neuropsychobiological distress, or even vigorous singing. 68 references.
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Common Infections and Inflammations and Other Conditions Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 429-439. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287.
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Summary: This chapter, from a book on the clinical care of the professional voice, reviews common infections and inflammations and other conditions. Topics include upper respiratory tract infection without laryngitis, tonsillitis, sinusitis, laryngitis with serious vocal fold injury, laryngitis without serious vocal fold damage, infection in the lower respiratory tract and elsewhere, Lyme disease, AIDS, and systemic diseases that may affect the voice. The author concludes by reminding readers that laryngeal manifestations of many systemic diseases may cause voice changes that cause the patient to seek medical attention for the first time. 1 figure. 48 references. ·
Ear, Nose, and Throat Disorders Source: in Cahill, M., et al. Professional Guide to Diseases. 5th ed. Springhouse, PA: Springhouse Corporation. 1995. p. 1190-1229. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 346-7844 or (215) 6468700; Fax (215) 646-4508. PRICE: $34.95 plus shipping and handling. ISBN: 0874347696. Summary: This chapter, from a quick reference guide for physicians, reviews ear, nose, and throat disorders. Disorders covered include otitis externa, benign tumors of the ear canal, otitis media, mastoiditis, otosclerosis, infectious myringitis, Meniere's disease, labyrinthitis, hearing loss, motion sickness, epistaxis (nosebleed), septal perforation and deviation, sinusitis, nasal polyps, nasal papillomas, adenoid hyperplasia, velopharyngeal insufficiency, pharyngitis, tonsillitis, throat abscesses, vocal cord paralysis, vocal cord nodules and polyps, laryngitis, and juvenile angiofibroma. For each disorder, the guide provides a discussion of causes and incidence, signs and symptoms, diagnosis, treatment, and special considerations. 7 figures. 1 table. 5 references.
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Respiratory Disorders Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 154-172. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail:
[email protected]. Website: www.bh.com. PRICE: $110.00. ISBN: 0723610568. Summary: Respiratory disorders are common and may significantly affect dental treatment, especially general anesthesia. Respiratory diseases are often also a contraindication to opioids, benzodiazepines and other respiratory depressants. This chapter on respiratory disorders is
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from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. Topics include upper respiratory tract viral infections, sinusitis, lower respiratory tract infections, pulmonary tuberculosis, Legionnaire's disease (legionellosis), lung abscess, bronchiectasis, cystic fibrosis, chronic obstructive airways diseases, asthma, bronchogenic carcinoma (lung cancer), occupational lung disease, sarcoidosis, postoperative respiratory complications (including aspiration of gastric contents), obstructive sleep apnea syndrome, and respiratory distress syndromes (RDS). For each disease, the authors discuss general aspects, diagnosis and management issues, dental aspects, and patient care strategies. The chapter includes a summary of the points covered. 1 figure. 5 tables. 51 references. ·
Extraoral Sources of Facial Pain Source: in Montgomery, M.T.; Redding, S.W., eds. Oral-Facial Emergencies: Diagnosis and Management. Portland, OR: JBK Publishing, Inc. 1994. p. 335-366. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Fax (312) 440-2824. PRICE: $27.00 (member) or $30.00 (nonmember), plus shipping and handling; institutional prices and bulk orders available. ISBN: 0945892055. Summary: This chapter on extraoral sources of facial pain is from an emergency room handbook that addresses a variety of orofacial injuries that are likely to be encountered in an acute care setting. The numerous organs that lie within the face and skull, their rich innervation, and the variety of ailments to which they are susceptible account for the extensive and complicated array of pains found in the craniofacial region. Pain may arise from intraoral sources such as the teeth, periodontium and jaws and from extraoral sources including ligaments and muscles of the head, neck and face; the nasal cavity and paranasal sinuses; the temporomandibular joints; eyes and ears; blood vessels of the scalp and face; dural and intracerebral arteries; and the cranial and cervical nerves. The author notes that the pathophysiology responsible for most facial pain is illdefined, requiring that most treatment be palliative rather than disease specific. The author focuses on assisting primary care providers in developing a differential diagnosis, the delivery of any needed emergency treatment, and the appropriate referral of patients who present with craniofacial pain from nonodontogenic sources (i.e., neuralgias, headaches, sinusitis). The authors present a diagnostic workup format appropriate for the emergency setting along with descriptions and treatment (both emergency and definitive) for some of
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the more common craniofacial pain entities. One chart summarizes the extraoral sources of facial pain. 3 figures. 5 tables. 28 references. (AA-M). ·
Sinusitis Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 437-439. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail:
[email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter, from a book on the clinical care of the professional voice, discusses infections and allergies affecting paranasal sinuses that can cause symptoms ranging from minor, chronic irritation to life threatening illness. Professional voice users can be especially sensitive to the manifestations of sinusitis, as they are to most diseases affecting the upper respiratory tract. Minor complaints can lead to alteration in technique, vocal fatigue, and loss of vocal range. Serious sinus infections can result in disruptions in performance schedules. The authors discuss the anatomy of the paranasal sinuses, the symptoms of acute sinusitis, nasal polyps, the impact of allergies (allergic rhinitis), the diagnosis of sinus disease, the medical treatment for chronic sinusitis, endoscopic sinus surgery, and traditional surgical options for sinus problems. The authors conclude that sinusitis is a common illness that can greatly affect professional voice users because of the direct effect on mucous production and consistency in the vocal tract, nasal obstruction, loss of nasal resonance, and the debilitating effects of a generalized, potentially serious illness.
General Home References In addition to references for sinusitis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Epidemic! The World of Infectious Disease by Rob Desalle (Editor), Paperback – 246 pages, 1st edition (September 1999), New Press; ISBN: 1565845463; http://www.amazon.com/exec/obidos/ASIN/1565845463/icongroupinterna
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· Handbook of Diseases; Paperback -- 986 pages, 2nd edition (January 15, 2000), Springhouse Pub Co; ISBN: 0874349796; http://www.amazon.com/exec/obidos/ASIN/0874349796/icongroupinterna · Infectious Disease Secrets by Robert H. Gates (Editor); Paperback – 400 pages, 1st edition (January 15, 1998), Hanley & Belfus; ISBN: 1560532661; http://www.amazon.com/exec/obidos/ASIN/1560532661/icongroupinterna · Invisible Enemies: Stories of Infectious Disease by Jeanette Farrell; Hardcover – 224 pages (April 1998), Farrar, Straus & Giroux (Juv); ISBN: 0374336377; http://www.amazon.com/exec/obidos/ASIN/0374336377/icongroupinterna · Maneater: And Other True Stories of a Life in Infectious Disease by Pamela Nagami; Hardcover – 287 pages, 1st edition (November 2001), St. Martin’s Press; ISBN: 1580632092; http://www.amazon.com/exec/obidos/ASIN/1580632092/icongroupinterna
Vocabulary Builder Abrasion: 1. the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. an area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Actinomycosis: Infections with bacteria of the genus actinomyces. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Asymptomatic: Showing or causing no symptoms. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteremia: The presence of viable bacteria circulating in the blood. Fever,
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chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Bronchiectasis: Chronic dilatation of the bronchi marked by fetid breath and paroxysmal coughing, with the expectoration of mucopurulent matter. It may effect the tube uniformly (cylindric b.), or occur in irregular pockets (sacculated b.) or the dilated tubes may have terminal bulbous enlargements (fusiform b.). [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully
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and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cystitis: Inflammation of the urinary bladder. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Enterobacter: Gram-negative gas-producing rods found in feces of man and other animals, sewage, soil, water, and dairy products. [NIH] Epistaxis: Nosebleed; haemorrhage from the nose. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural,
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pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Geotrichosis: Infection due to the fungus Geotrichum. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hyperacusis: An abnormally disproportionate increase in the sensation of loudness in response to auditory stimuli of normal volume. Cochlear diseases; vestibulocochlear nerve diseases; facial nerve diseases; stapes surgery; and other disorders may be associated with this condition. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU]
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Insomnia: Inability to sleep; abnormal wakefulness. [EU] Klebsiella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms arrange singly, in pairs, or short chains. This genus is commonly found in the intestinal tract and is an opportunistic pathogen that can give rise to bacteremia, pneumonia, urinary tract and several other types of human infection. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Laryngitis: Inflammation of the larynx, a condition attended with dryness and soreness of the throat, hoarseness, cough and dysphagia. [EU] Legionellosis: Infections with bacteria of the genus LEGIONELLA. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mastoiditis: Inflammation of the mastoid antrum and cells. [EU] Mycobacterium: An organism of the genus Mycobacterium. [EU] Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU]
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Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU]
Otosclerosis: A pathological condition of the bony labyrinth of the ear, in which there is formation of spongy bone (otospongiosis), especially in front of and posterior to the footplate of the stapes; it may cause bony ankylosis of the stapes, resulting in conductive hearing loss. Cochlear otosclerosis may also develop, resulting in sensorineural hearing loss. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Papillomavirus: A genus of papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH]
Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]
Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Pharyngitis: Inflammation of the pharynx. [EU] Postoperative: Occurring after a surgical operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the
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interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Spasmodic: Of the nature of a spasm. [EU] Squamous: Scaly, or platelike. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Thrombocytopenia: Decrease in the number of blood platelets. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. [EU] Toxoplasmosis: An acute or chronic, widespread disease of animals and humans caused by the obligate intracellular protozoon Toxoplasma gondii, transmitted by oocysts containing the pathogen in the feces of cats (the definitive host), usually by contaminated soil, direct exposure to infected feces, tissue cysts in infected meat, or tachyzoites (proliferating forms) in blood. [EU] Tracheotomy: Surgical incision of the trachea. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU]
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Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Varicella: Chicken pox. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vulvovaginitis: Inflammation of the vulva and vagina, or of the vulvovaginal glands. [EU] Xerostomia: Dryness of the mouth from salivary gland dysfunction, as in Sjögren's syndrome. [EU]
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CHAPTER 7. MULTIMEDIA ON SINUSITIS Overview Information on sinusitis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on sinusitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Bibliography: Multimedia on Sinusitis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in sinusitis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on sinusitis. For more information, follow the hyperlink indicated: ·
“Sinus” or sinusitis. Source: University of Michigan Medical Center Department of Postgraduate Medicine and Health Professions Education Independent Study Unit; Year: 1976; Format: Slide; Ann Arbor: The University: [for loan or sale by its Medical Center Media Library], c1976
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Acute frontal sinusitis. Source: [production company unknown; Raphael Schillinger]; Year: 1932; Format: Motion picture; [S.l.: s.n., 1932]
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Bilateral osteoplastic frontal sinus operation. Source: Massachusetts Eye & Ear Infirmary; produced by Dekko Films; Year: 1965; Format: Motion picture; Kenilworth, N. J.: Schering Corp.: c1965
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Diagnosis and treatment of sinusitis. Source: American Academy of Family Physicians; produced by Gardiner-Caldwell SynerMed; Year: 1996; Format: Videorecording; Kansas City, Mo.: American Academy of Family Physicians, c1996
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Differential diagnosis, evaluation, and treatment of sinusitis. Source: Gary Incaudo, M. Eric Gershwin, Stephen M. Nagy, Jr; Year: 1986; Format: Slide; Garden Grove, Calif.: Medcom, c1986
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Evaluation and management of chronic nasal symptoms. Source: M. Eric Gershwin, Paul J. Donald, Stephen M. Nagy, Jr; Year: 1981; Format: Slide; [New York]: Medcom, c1981
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Pathway to improve outcomes : colds, allergies & sinus infections. Source: Education Design; Year: 1995; Format: Videorecording; Denver, Colo.: Education Design, c1995
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Primary care : sinusitis. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1996; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1996
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Radiology as it relates to sinus and allergy. Source: [presented by] EduMed Corporation; Year: 1999; Format: Videorecording; Minnetonka, MN: EduMed, c1999
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Sinusitis : a slide lecture series of the American Academy of Otolaryngology-- Head and Neck Surgery. Year: 1988; Format: Slide; [Washington, D.C.]: American Academy of Otolaryngology--Head and Neck Surgery Foundation, c1988
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Sinusitis : management guidelines vs. current practice: a national video conference. Source: produced by Health Communications, Inc; Year: 1994; Format: Videorecording; Secaucus, NJ: Network for Continuing Medical Education, c1994
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Sinusitis and pharyngitis : more than just a cold. Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; [United States]: Information Television Network, c1996
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Sinusitis. Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998
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Sinusitis. Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital [and] Marshfield Medical Research Foundation; Year: 1991; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, [1991]
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Sinusitis. Source: endoscopic surgery ; Year: 1991; Format: Slide; [Columbus, Ohio]: Ohio Medical Education Network, [1991]
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CHAPTER 8. PERIODICALS AND NEWS ON SINUSITIS Overview Keeping up on the news relating to sinusitis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on sinusitis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover sinusitis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on sinusitis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “sinusitis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Aventis Reports Second-Quarter and Half-Year Results for 2002 Summary: FORT WASHINGTON, Pa., July 11 /PRNewswire/ -Tylenol(R) Cold Day/Night and Tylenol(R) Sinus Day/Night Convenience Packs are being introduced this month from McNeil Consumer & Specialty Pharmaceuticals, the maker of Tylenol(R). These are the first such combo packs to be launched under the brand's name. The two new day/night packages each contain two formulas: 1) nondrowsy caplets for day-time use; and 2) night-time caplets with an antihistamine to help promote restful sleep. "We're pleased to offer consumers an easy solution for the discomfort of cold and sinus symptoms," said Bob Carpenter, Vice President, Marketing, McNeil Consumer & Specialty Pharmaceuticals. "A single package offers round-the-clock symptom relief -- a day-time formula that doesn't cause drowsiness and a separate night-time formula that allows people to get the rest they need at night." Since the first Tylenol(R) cold medicine was introduced in 1969, Tylenol(R) has been used by millions of people for relief of the pain, sore throat, cough, and nasal congestion often associated with the common cold and sinusitis. Tylenol(R) Cold Day/Night and Tylenol(R) Sinus Day/Night packs contain the same active ingredients as the individually sold multi-symptom versions of each product currently available. The separate blister packages of day and night caplets are easily distinguishable from each other. The importance of acetaminophen as a part of cold symptom relief was recently reinforced by the American Lung Association, whose guidelines for the prevention and treatment of the common cold recommend acetaminophen, the medicine in Tylenol(R), as first-line therapy for the aches and pains associated with common infections of the respiratory system.
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Tylenol(R) Cold Day/Night and Tylenol(R) Sinus Day/Night convenience packs will be available in July at retail outlets nationwide, including food, drug and mass merchandisers. McNeil Consumer & Specialty Pharmaceuticals is North America's leading producer and marketer of over-the-counter pharmaceuticals, including Tylenol(R), the number-one pain reliever/fever reducer in the world; Motrin(R) ibuprofen; Imodium and St. Joseph(R) aspirin. Headquartered in Fort Washington, PA, McNeil C&SP also markets Concerta(R) for ADHD. Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to sinusitis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “sinusitis” (or synonyms). The following was recently listed in this archive for sinusitis: ·
First-, second-generation antibiotics comparable for sinusitis Source: Reuters Industry Breifing Date: October 17, 2001 http://www.reuters.gov/archive/2001/10/17/business/links/20011017 clin003.html
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Stepwise protocol proposed for treatment of pediatric chronic sinusitis Source: Reuters Medical News Date: September 25, 2001 http://www.reuters.gov/archive/2001/09/25/professional/links/20010 925clin011.html
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Sinusitis may be a risk factor for ischemic stroke Source: Reuters Medical News Date: August 16, 2001 http://www.reuters.gov/archive/2001/08/16/professional/links/20010 816epid005.html
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Inspire begins phase I testing of P2Y2 agonist in sinusitis Source: Reuters Industry Breifing Date: August 14, 2001 http://www.reuters.gov/archive/2001/08/14/business/links/20010814 drgd005.html
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Antibiotics don't speed sinusitis recovery: study Source: Reuters Health eLine Date: April 02, 2001 http://www.reuters.gov/archive/2001/04/02/eline/links/20010402elin 003.html
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Sinusitis linked to airway inflammation in severe asthmatics Source: Reuters Medical News Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/professional/links/20020 502clin008.html
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Chronic sinusitis linked to cystic fibrosis gene Source: Reuters Health eLine Date: January 07, 2002 http://www.reuters.gov/archive/2002/01/07/eline/links/20020107elin 002.html
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Fluticasone aids antibiotic rhinosinusitis therapy Source: Reuters Industry Breifing Date: December 26, 2001 http://www.reuters.gov/archive/2001/12/26/business/links/20011226 clin008.html
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Antibiotic treatment unnecessary for most children with acute sinusitis Source: Reuters Industry Breifing Date: April 02, 2001 http://www.reuters.gov/archive/2001/04/02/business/links/20010402 clin001.html
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Severe asthmatics often have more serious rhinosinusitis Source: Reuters Medical News Date: February 26, 2001 http://www.reuters.gov/archive/2001/02/26/professional/links/20010 226clin017.html
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Sinusitis may increase ECP levels in asthmatic children Source: Reuters Medical News Date: December 22, 2000 http://www.reuters.gov/archive/2000/12/22/professional/links/20001 222clin005.html
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Clinical sinusitis common among children seen in primary care centers Source: Reuters Medical News Date: December 18, 2000 http://www.reuters.gov/archive/2000/12/18/professional/links/20001 218publ002.html
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Chronic rhinosinusitis in general population linked to CF gene mutations Source: Reuters Industry Breifing Date: October 11, 2000 http://www.reuters.gov/archive/2000/10/11/business/links/20001011 scie006.html
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Chronic sinus infections linked to cystic fibrosis gene Source: Reuters Health eLine Date: October 10, 2000 http://www.reuters.gov/archive/2000/10/10/eline/links/20001010elin 012.html
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Smoking raises risks of sinusitis Source: Reuters Health eLine Date: August 18, 2000 http://www.reuters.gov/archive/2000/08/18/eline/links/20000818elin 009.html
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New sinusitis treatment guidelines aim to cut emergence of antibiotic resistance Source: Reuters Industry Breifing Date: July 28, 2000 http://www.reuters.gov/archive/2000/07/28/business/links/20000728 plcy002.html
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New treatment guidelines help treat sinus infections Source: Reuters Health eLine Date: May 30, 2000 http://www.reuters.gov/archive/2000/05/30/eline/links/20000530elin 012.html
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Most anatomical variations of paranasal sinuses are unrelated to sinusitis Source: Reuters Medical News Date: May 17, 2000 http://www.reuters.gov/archive/2000/05/17/professional/links/20000 517clin008.html
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More than half of patients with chronic rhinosinusitis do not benefit from surgery Source: Reuters Medical News Date: May 02, 2000 http://www.reuters.gov/archive/2000/05/02/professional/links/20000 502clin007.html
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Concomitant sinusitis and organ rejection reported in two lung recipients Source: Reuters Medical News Date: March 13, 2000 http://www.reuters.gov/archive/2000/03/13/professional/links/20000 313clin016.html
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Clarithromycin shows anti-inflammatory properties in patients with sinusitis Source: Reuters Medical News Date: February 01, 2000 http://www.reuters.gov/archive/2000/02/01/professional/links/20000 201clin013.html
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Endoscopic surgery better that adenoidectomy in treatment of pediatric sinusitis Source: Reuters Medical News Date: November 18, 1999 http://www.reuters.gov/archive/1999/11/18/professional/links/19991 118clin004.html
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Headache symptoms do not reflect severity of sinusitis Source: Reuters Medical News Date: September 27, 1999 http://www.reuters.gov/archive/1999/09/27/professional/links/19990 927clin012.html
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CT scan urged for sinusitis patients with headache Source: Reuters Health eLine Date: September 27, 1999 http://www.reuters.gov/archive/1999/09/27/eline/links/19990927elin 002.html
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Chronic sinusitis caused by fungus Source: Reuters Health eLine Date: September 14, 1999 http://www.reuters.gov/archive/1999/09/14/eline/links/19990914elin 001.html
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Refractory sinusitis in HIV-infected patients relieved with endoscopic surgery Source: Reuters Medical News Date: April 28, 1999 http://www.reuters.gov/archive/1999/04/28/professional/links/19990 428clin012.html
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Metarrhizium anisopliae causes sinusitis in immunocompetent patients Source: Reuters Medical News Date: January 29, 1999 http://www.reuters.gov/archive/1999/01/29/professional/links/19990 129clin006.html
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Immunotherapy effective in atopic patients with sinusitis Source: Reuters Medical News Date: November 13, 1998 http://www.reuters.gov/archive/1998/11/13/professional/links/19981 113clin005.html
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Migraine variant may present as chronic sinusitis Source: Reuters Medical News Date: November 10, 1998 http://www.reuters.gov/archive/1998/11/10/professional/links/19981 110clin013.html
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Acute sinusitis common among HIV-positive children Source: Reuters Medical News Date: September 10, 1998 http://www.reuters.gov/archive/1998/09/10/professional/links/19980 910clin003.html
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Hypertonic saline effective therapy for pediatric chronic sinusitis Source: Reuters Medical News Date: June 01, 1998 http://www.reuters.gov/archive/1998/06/01/professional/links/19980 601clin006.html
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Sinus Infections Rare In Children Under 5 Source: Reuters Health eLine Date: April 23, 1998 http://www.reuters.gov/archive/1998/04/23/eline/links/19980423elin 014.html
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Sinusitis Uncommon In Children Aged 1 To 5 Years Source: Reuters Medical News Date: March 30, 1998 http://www.reuters.gov/archive/1998/03/30/professional/links/19980 330epid001.html
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Sinusitis Not Linked To Asthma Symptom Severity Source: Reuters Medical News Date: March 18, 1998 http://www.reuters.gov/archive/1998/03/18/professional/links/19980 318clin011.html
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Duration Of Nasal Discharge Distinguishes Sinusitis From Rhinitis Source: Reuters Medical News Date: December 02, 1997 http://www.reuters.gov/archive/1997/12/02/professional/links/19971 202clin005.html
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Effectiveness Of Different Antibiotic Treatments For Acute Maxillary Sinusitis Similar Source: Reuters Medical News Date: September 18, 1997 http://www.reuters.gov/archive/1997/09/18/professional/links/19970 918clin008.html
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IV Immune Globulin Improves Chronic Sinusitis In Some Children Source: Reuters Medical News Date: September 10, 1997 http://www.reuters.gov/archive/1997/09/10/professional/links/19970 910clin005.html
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AIDS-Associated Parasitic Sinusitis/Otitis Often Recurrent Source: Reuters Medical News Date: September 02, 1997 http://www.reuters.gov/archive/1997/09/02/professional/links/19970 902clin007.html
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Sinusitis Therapy May Reduce Symptoms In Pediatric Asthma Source: Reuters Medical News Date: August 07, 1997 http://www.reuters.gov/archive/1997/08/07/professional/links/19970 807clin010.html
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Acute Rhinosinusitis: Symptomatic Treatment Best Initially Source: Reuters Medical News Date: March 07, 1997 http://www.reuters.gov/archive/1997/03/07/professional/links/19970 307clin007.html
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Patients With Chronic Sinusitis Have Reduced Antioxidant Defense Source: Reuters Medical News Date: February 27, 1997 http://www.reuters.gov/archive/1997/02/27/professional/links/19970 227clin005.html
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Passive Smoke Increases Risk Of Sinusitis In Asthmatic Children Source: Reuters Medical News Date: February 24, 1997 http://www.reuters.gov/archive/1997/02/24/professional/links/19970 224clin005.html The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to sinusitis: ·
Hum for Your Health! It May Help Your Sinuses http://www.nlm.nih.gov/medlineplus/news/fullstory_8632.html
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “sinusitis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “sinusitis” (or synonyms). If you know the name of a company that is relevant to sinusitis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “sinusitis” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “sinusitis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on sinusitis: ·
Loss of Smell: When the Nose Doesn't Know Source: Harvard Health Letter. 22(4): 6-7. February 1997. Contact: Available from Harvard Health Letter. P.O. Box 380, Boston, MA 02117. (800) 829-9045 or (617) 432-1485.
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Summary: This health newsletter article reviews the sense of smell and the occurrence of smell disorders. The author first reviews the physiology of smell, noting that as with sight and hearing, the acuity of this sensory ability decreases with age. The causes for smell impairments are then reviewed, including septal deviations and chronic sinusitis (which can cause persistent nasal obstruction), trauma to the head or nose, or a viral illness. Progressive neurological disorders, such as Alzheimer disease, Parkinson disease or multiple sclerosis, can affect the olfactory (smell) nerves, and loss of smell can be a warning sign for these conditions. Other causes can include nutritional deficiencies or medication effects. The author briefly outlines the types of diagnostic testing that can be done to establish and define the presence of a smell disorder. The article concludes with a review of the safety issues for the home of a person who do not have an adequate sense of smell. 1 figure.
Academic Periodicals covering Sinusitis Academic periodicals can be a highly technical yet valuable source of information on sinusitis. We have compiled the following list of periodicals known to publish articles relating to sinusitis and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on sinusitis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on sinusitis: ·
Allergologia Et Immunopathologia. (Allergol Immunopathol (Madr)) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=All ergologia+Et+Immunopathologia&dispmax=20&dispstart=0
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Clinical and Experimental Immunology. (Clin Exp Immunol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+and+Experimental+Immunology&dispmax=20&dispstart=0
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Journal of Manipulative and Physiological Therapeutics. (J Manipulative Physiol Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Manipulative+and+Physiological+Therapeutics&dispmax=20& dispstart=0
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Journal of Neurology, Neurosurgery, and Psychiatry. (J Neurol Neurosurg Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Neurology,+Neurosurgery,+and+Psychiatry&dispmax=20&dis pstart=0
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Journal of Toxicology. Clinical Toxicology. (J Toxicol Clin Toxicol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Toxicology.+Clinical+Toxicology&dispmax=20&dispstart=0
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South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. (S Afr Med J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=So uth+African+Medical+Journal.+SuidAfrikaanse+Tydskrif+Vir+Geneeskunde&dispmax=20&dispstart=0
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The Journal of Laryngology and Otology. (J Laryngol Otol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Laryngology+and+Otology&dispmax=20&dispstart=0
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The Laryngoscope. (Laryngoscope) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Laryngoscope&dispmax=20&dispstart=0
Vocabulary Builder Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU]
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Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Giardia: A genus of flagellate intestinal protozoa parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/health/diseases.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology,
