The role of antibiotics in treating chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses that occurs in 1% to 5% of the U.S. It may significantly decrease quality of life. CRS is defined as an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. Treatment is directed at enhancing mucociliary clearance, improving sinus drainage/outflow, eradicating local infection (with antibiotics) and inflammation (with steroids), and improving access for topical medications.

The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates.

Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Antimicrobialtherapy of chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. Because most of these infections are polymicrobial and many include beta-lactamase producing aerobic and anaerobic organisms, amoxicillin-clavulanate is the first-line regimen for most patients. Clindamycin is adequate for penicillin-allergic individuals and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. Treatment can be guided by a culture preferably from the sinus cavity obtained from individuals who have not shown improvement or deteriorated despite therapy.

Chronic sinusitis is associated with higher risk of some head and neck cancers

Chronic rhino-sinusitis (CRS) may be involved in causing of certain head and neck cancers (HNCs), because of immunodeficiency or inflammation.

Several studies explored this issue. Tsou et al. who studied the Taiwan Longitudinal Health Insurance Database found a 3.55-fold increased risk of developing nasopharyngeal cancer (NPC) compared with individuals without rhinosinusitis associations between and CRS throughout a 3-year period. 

Riley et al. conducted a systematic review found a 2.7- fold increased risk of developing NPC in patients with CRS compared with patients without sinusitis.  

Beachler and Engels of the National Institutes of Health, Bethesda, Maryland evaluated the associations of chronic sinusitis with subsequent HNC, including NPC, human papillomavirus-related oropharyngeal cancer (HPV-OPC), and nasal cavity and paranasal sinus cancer (NCPSC), in an elderly US individuals. They evaluated 483 546 Medicare beneficiaries treated from 2004 through 2011. CRS was associated with increased risk of developing particularly NPC, HPV-OPC, and NCPSC within 1 year of the chronic sinusitis diagnosis. Overall, the risk of any HNC type was 8% higher in patients with CRS than individuals without chronic sinusitis.

Future studies are warranted to evaluate whether inflammation in patients with sinusitis contributes to emergence of cancer, especially in middle-aged adults.