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Sinusitis: Subacute Sinusitis
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Subacute Sinusitis represents a continuum of the natural progression of acute Sinusitis that has not resolved. This condition is diagnosed after a 4-week duration of acute Sinusitis, and it lasts up to 12 weeks. Subacute Sinusitis is not known to represent a discrete histopathologic entity, but it may warrant therapy different from that for either acute Sinusitis or chronic Sinusitis. Patients with subacute Sinusitis may or may not have been treated for the acute phase, and the symptoms are less severe than in acute Sinusitis. Thus, unlike in acute Sinusitis, fever would not be considered a major factor. The clinical factors required for the diagnosis of subacute adult Sinusitis are the same for those for chronic Sinusitis.
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Sinusitis can be subdivided into acute, subacute, and chronic disease. Acute sinusitis is defined as disease lasting less than 1 month, subacute disease lasts 1-3 months, and chronic sinusitis lasts longer than 3 months and generally related to suboptimally treated acute or subacute disease. Acute and subacute sinusitis is treated medically, whereas chronic sinusitis may require surgical intervention.
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Sinusitis can be divided into: acute, which is often caused by a bacterial infection. It usually develops as a complication of a viral respiratory infection, common cold, and symptoms last less than four weeks; subacute, with symptoms lasting from 4 to 8 weeks; chronic, which symptoms last eight weeks or longer of varying severity and is often a chronic inflammatory disorder similar to bronchial asthma; and recurrent sinusitis, which is three or more episodes of acute sinusitis per year.
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This practice guideline focuses on the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute bacterial sinusitis. Neonates and children younger than 1 year of age are not considered. Although bacterial sinusitis does occur rarely in children less than 1 year of age, their exclusion reflects, in part, the difficulty in conducting clinical investigation in this age group. This is a consequence of the small size of the paranasal sinuses and the difficulty in safely performing sinus aspiration.12 This practice parameter does not apply to children with previously recognized anatomic abnormalities of their paranasal sinuses (facial dysmorphisms or trauma), immunodeficiencies, cystic fibrosis, or immotile cilia syndrome.
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Acute and subacute bacterial sinusitis is usually best treated with appropriate antibiotics at an appropriate dose for the appropriate amount of time (usually 14-21 days). The antibiotics are usually continued for at least 7 days after symptoms disappear. If symptoms worsen or do not improve, the antibiotic is usually changed early in the course.
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Subacute Sinusitis