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2017 ; 8
(2
): 45-52
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Differential diagnosis and proper treatment of acute rhinosinusitis: Guidance
based on historical data analysis
#MMPMID28583227
Cevc G
Allergy Rhinol (Providence)
2017[Jun]; 8
(2
): 45-52
PMID28583227
show ga
BACKGROUND: The time course of rhinovirus positive and negative rhinosinusitis
has not been quantified yet, which aggravates proper selection and justification
of the optimum treatment for this illness. Such quantitative information would
facilitate an early and proper identification of the disease and its
differentiation from acute bacterial rhinosinusitis, and could diminish harmful
overuse of antibiotics, arguably driven by patients' want for attention and the
treating physicians' inability to offer an adequate verbal comfort in its stead.
OBJECTIVE: Extraction of the quantitative information needed to identify
rhinovirus positive or negative rhinosinusitis and to allow selection of the most
appropriate treatment from the published time dependence of individual clinical
symptoms of the disease. METHODS: Scrutiny (and modeling) of temporal evolution
of all noteworthy symptoms of rhinosinusitis with a simple mathematical
expression that relies on two adjustable parameters per symptom (and potentially
a general time offset as an extra adjustable parameter). RESULTS: Adverse effects
of rhinosinusitis can be grouped according to the sequence of their exponential
appearance and ?2.6 times slower exponential disappearance, rhinovirus negative
rhinosinusitis generally improving ?25% faster and being ?40% less severe. The
major early local symptoms (throat soreness and scratchiness, headache) vanish
with a half-life of ?1.8 days, whereas further local symptoms take ?1.6 times
longer to disappear. At least 50-60% improvement of two prominent early symptoms,
sore throat and sneezing (but not of nasal discharge, cough, and hoarseness) by
day 5 of the disease implies a nonbacterial origin of rhinitis and should exclude
use of antibiotics. CONCLUSION: Temporal evolution of all rhinosinusitis symptoms
is qualitatively similar, which makes the early symptom decay a good proxy for,
and predictor of, the disease perspective. Knowing a symptom intensity at just
three to four time points suffices for reconstructing its entire time course and
total intensity or gravity. This permits an easy and early identification of
rhinosinusitis, and its plausible differentiation from acute bacterial
rhinosinusitis, disease treatment optimization, and corresponding clinical trials
simplification and/or shortening.