Akute Rhinosinusitis bei Erwachsenen – EPOS 2012 Teil II

Zusammenfassung

Die Rhinosinusitis (RS) ist eine Entzündung der Schleimhaut von Nase und Nasennebenhöhlen, die im Regelfall gemeinsam betroffen sind. Es gibt zahlreiche Leitlinien und Positionspapiere zur Rhinosinusitis. Aktuell und umfassend ist das Positionspapier „EPOS 2012“ der European Rhinologic Society und der European Academy of Allergy and Clinical Immunology. Die EPOS2012-Expertengruppe sieht als zentrales pathophysiologisches Element dieser Erkrankung die Entzündung an, nicht die Infektion. Zunächst werden diagnostische Kriterien für die RS allgemein (akut und chronisch) definiert. Rhinosinusitiden mit einer Krankheitsdauer unter 12 Wochen werden als akut kategorisiert. Ungefähr 10% der Bevölkerung Europas leiden im Jahresmittel an einer akuten Rhinosinusitis. Die akute RS wird weiter unterteilt in akut viral, akut postviral und akut bakteriell. Für die einzelnen Subtypen der akuten RS wurden dezidierte diagnostische Kriterien entwickelt. Die akut virale RS entspricht einem oberen Atemwegsinfekt, die akut postvirale RS stellt eine Zwischenstufe zur akut bakteriellen RS dar. Für die akut virale RS findet sich im Positionspapier eine Bewertung von OTC-Erkältungsmitteln. Der Stellenwert einer topischen Steroidtherapie bei der akut postviralen RS wird anhand aktueller Studien dargestellt. Die Indikationen und die Vor- und Nachteile einer antibiotischen Therapie bei akut bakterieller RS werden von der EPOS2012-Expertenkommission kritisch gewertet. Insgesamt erfährt dieses medizinisch, pharmazeutisch und gesundheitsökonomisch relevante Gebiet derzeit eine Neuorientierung, die sich in den nächsten Jahren auch im Praxis-Alltag bemerkbar machen wird.

Abstract

Rhinosinusitis (RS) is an inflammatory disorder of the mucous membranes of the nose and paranasal sinuses, which are almost always affected concurrently. The EPOS2012 position paper initiated by the European Rhinologic Society and the European Academy of Allergy and Clinical Immunology is a recent comprehensive source on this common disease affecting approximately 20% of the population worldwide.

Inflammation, not infection, is considered the cornerstone of RS, which is considered a temporal and pathophysiologic disease continuum with various subtypes. Acute rhinosinusitis is ­diagnosed, if typical symptoms last less than 12 weeks. It affects approximately 10% of the European population. Acute RS is further subdivided into acute viral, acute postviral and acute bacterial RS. Acute viral RS lasts less than 10 days with decreasing symptom intensity, while acute postviral RS is characterized by longer duration or a sudden increase of symptom seve­rity around the 5th day (‘double sickening’). Acute bacterial RS is assumed if 3 of the following 5 criteria are additionally met: Discoloured discharge (with unilateral predominance), severe local pain (with unilateral predominance), fever (>38ºC), elevated ESR/CRP, and ‘double ­sickening’.

For the treatment of acute viral RS, nasal saline irrigations and OTC cold remedies are advised. In acute postviral RS, additional topical steroids are suggested. Advantages and disadvantages of antibiotic treatment in acute bacterial RS are detailed. Overall, the new EPOS position paper infers a reorientation in this area of high medical, pharmaceutical and economic relevance.

Schlüsselwörter

Akute Rhinosinusitis - Leitlinien - akut viral - akut postviral - akut bakteriell

Key words

acute rhinosinusitis - guidelines - adult - classification - nasal polyps

• Literatur

• 1 Fokkens WJ, Lund VJ, Mullol J et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012; 50: 1-12
• 2 Riechelmann H. Chronische Rhinosinusitis – EPOS 2012 Teil I. Laryngorhinootologie 2013; 92: 193-201
• 3 Rosenfeld RM, Andes D, Bhattacharyya N et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007; 137: S1-S31
• 4 Young J, De Sutter A, Merenstein D et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008; 371: 908-914
• 5 Falagas ME, Giannopoulou KP, Vardakas KZ et al. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. Lancet Infect Dis 2008; 8: 543-552
• 6 Lindbaek M, Hjortdahl P, Johnsen UL. Use of symptoms, signs, and blood tests to diagnose acute sinus infections in primary care: comparison with computed tomography. Fam Med 1996; 28: 183-188
• 7 Moayyedi P, Leontiadis GI. The risks of PPI therapy. Nat Rev Gastroenterol Hepatol 2012; 9: 132-139
• 8 Pathologische Anatomie der chronischen Rhinitis und Sinusitis . Proceedings VIII International Congress of Oto-Rhino-Laryngology Tokyo, 1965, 113. p. 80. IV. Amsterdam – New York: Excerpta Medica Foundation; 1965
• 9 Puhakka T, Makela MJ, Alanen A et al. Sinusitis in the common cold. J Allergy Clin Immunol 1998; 102: 403-408
• 10 Gwaltney Jr JM, Phillips CD, Miller RD et al. Computed tomographic study of the common cold. N Engl J Med 1994; 330: 25-30
• 11 Turner BW, Cail WS, Hendley JO et al. Physiologic abnormalities in the paranasal sinuses during experimental rhinovirus colds. J Allergy Clin Immunol 1992; 90: 474-478
• 12 Hickner JM, Bartlett JG, Besser RE et al. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med 2001; 134: 498-505
• 13 Shekelle PG, Woolf SH, Eccles M et al. Clinical guidelines: developing guidelines. Bmj 1999; 318: 593-596
• 14 Kassel JC, King D, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2010; CD006821
• 15 Hildenbrand T, Weber R, Heubach C et al. Nasenspülungen bei akuter Rhinosinusitis. Laryngorhinootologie 2011; 90: 346-351
• 16 Bollag U, Albrecht E, Wingert W. Medicated versus saline nose drops in the management of upper respiratory infection. Helv Paediatr Acta 1984; 39: 341-345
• 17 Adam P, Stiffman M, Blake Jr RL. A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Arch Fam Med 1998; 7: 39-43
• 18 Slapak I, Skoupa J, Strnad P et al. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg 2008; 134: 67-74
• 19 De Sutter AI, van Driel ML, Kumar AA et al. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev 2012; 2 CD004976
• 20 Eccles R, van Cauwenberge P, Tetzloff W et al. A clinical study to evaluate the efficacy of the antihistamine doxylamine succinate in the relief of runny nose and sneezing associated with upper respiratory tract infection. J Pharm Pharmacol 1995; 47: 990-993
• 21 Eccles R, Jawad MS, Jawad SS et al. Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold. Am J Rhinol 2005; 19: 25-31
• 22 Eccles R, Jawad M, Jawad S et al. Efficacy of a paracetamol-pseudoephedrine combination for treatment of nasal congestion and pain-related symptoms in upper respiratory tract infection. Curr Med Res Opin 2006; 22: 2411-2418
• 23 Albalawi ZH, Othman SS, Alfaleh K. Intranasal ipratropium bromide for the common cold. Cochrane Database Syst Rev 2011; 7 CD008231
• 24 Eccles R, Pedersen A, Regberg D et al. Efficacy and safety of topical combinations of ipratropium and xylometazoline for the treatment of symptoms of runny nose and nasal congestion associated with acute upper respiratory tract infection. Am J Rhinol 2007; 21: 40-45
• 25 Hao Q, Lu Z, Dong BR et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev 2011; 9 CD006895
• 26 Eccles R, Martensson K, Chen SC. Effects of intranasal xylometazoline, alone or in combination with ipratropium, in patients with common cold. Curr Med Res Opin 2010; 26: 889-899
• 27 Eccles R, Eriksson M, Garreffa S et al. The nasal decongestant effect of xylometazoline in the common cold. Am J Rhinol 2008; 22: 491-496
• 28 Meltzer EO, Bachert C, Staudinger H. Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol 2005; 116: 1289-1295
• 29 Bachert C, Meltzer EO. Effect of mometasone furoate nasal spray on quality of life of patients with acute rhinosinusitis. Rhinology 2007; 45: 190-196
• 30 Keith PK, Dymek A, Pfaar O et al. Fluticasone furoate nasal spray reduces symptoms of uncomplicated acute rhinosinusitis: a randomised placebo-controlled study. Prim Care Respir J 2012; 21: 267-275
• 31 Babar-Craig H, Gupta Y, Lund VJ. British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit. Rhinology 2010; 48: 344-347
• 32 Hansen FS, Hoffmans R, Georgalas C et al. Complications of acute rhinosinusitis in The Netherlands. Fam Pract 2012; 29: 147-153
• 33 Lindbaek M. Seeing what you want to see in randomised controlled trials. Meta-analyses may suffer from interpretation bias too. Bmj 2000; 321: 1079