Sinusitis and Pharyngitis

  • Paul Evans
  • William F. Miser


Sinusitis is a common problem encountered in primary care, seen in 3% of patients with upper respiratory tract infections (URIs).1 It is primarily caused by ostial obstruction of the anterior ethmoid and middle meatal complex due to retained secretions, edema, or polyps. Barotrauma, nasal cannulation, or ciliary transport defects can also precipitate infection.1,2 The diagnosis is sometimes elusive, requiring skillful medical detective work and careful clinical evaluation to identify the problem.


Sore Throat Chronic Sinusitis Acute Rheumatic Fever Acute Sinusitis Cefuroxime Axetil 


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  1. 1.
    Jeffers J, Boynton S. Harrison’s principles of internal medicine. 13th ed. New York: McGraw-Hill, 1995:418–21.Google Scholar
  2. 2.
    Linden B, Aguilar E, Allen S. Sinusitis in the nasotracheally intubated patient. Arch Otolaryngol Head Neck Surg 1988; 114:860–1.PubMedCrossRefGoogle Scholar
  3. 3.
    Way L. Current surgical diagnosis and treatment. 10th ed. East Norwalk, CT: Appleton & Lange, 1994:874–7.Google Scholar
  4. 4.
    Simon H. Approach to the patient with sinusitis. In: Goroll A, May L, Mulley A, editors. Primary care medicine. 3rd ed. Philadelphia: Lippincott, 1995:1004–7.Google Scholar
  5. 5.
    Tierney L, McPhee S, Papadakis M. Current medical diagnosis and treatment. 34th ed. East Norwalk, CT: Appleton & Lange, 1995:182–4.Google Scholar
  6. 6.
    Ferguson B. Acute and chronic sinusitis: how to ease symptoms and locate the cause. Postgrad Med 1995;97:45–57.PubMedGoogle Scholar
  7. 7.
    Burke T, Guertler A, Timmons J. Comparisons of sinus x-rays with CT scans in acute sinusitis. Acad Emerg Med 1994;1:235–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Yousem D. Imaging of sinonasal inflammatory disease. Radiology 1993;188:303–14.PubMedGoogle Scholar
  9. 9.
    Hopp R, Cooperstock M. Evaluation and treatment of sinusitis: aspects for the managed care environment. J Am Osteopathic Assoc 1996;96 Suppl 4:S6–10.Google Scholar
  10. 10.
    Guarderas J. Acute and chronic sinusitis. Mayo Clin Proc 1996;71:882–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Sanford J, Gilbert D, Sande M. Sanford’s guide to antimicrobial therapy. 26th ed. 1996:32–3. Dallas: Antimicrobial Therapy, Inc.Google Scholar
  12. 12.
    Hilger P. Diseases of the paranasal sinuses. In: Adams G, Boies L, Hilger P, editors. Fundamentals of otolaryngology. Philadelphia: Saunders, 1989:249–70.Google Scholar
  13. 13.
    Nord C. The role of anaerobic bacteria in recurrent episodes of sinusitis and tonsillitis. Clin Infect Dis 1995;20:1512–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Malm L. Pharmacological background to decongesting and anti-inflammatory treatment of rhinitis and sinusitis. Acta Otolaryngol Suppl (Stockh) 1994;515:53–5.CrossRefGoogle Scholar
  15. 15.
    Naclerio R. Allergic rhinitis. N Engl ] Med 1991;325:860–9.CrossRefGoogle Scholar
  16. 16.
    Tom L, Kennedy D. Rhinitis and sinusitis. In: Burg F, Ingelfinger J, Wald E, Polin R, editors. Current pediatric therapy. 15th ed. Philadelphia: Saunders, 1996.Google Scholar
  17. 17.
    Meilen I. Chronic sinusitis: clinical and pathophysiological aspects. Acta Otolaryngol Suppl (Stockh) 1994;515:45–8.CrossRefGoogle Scholar
  18. 18.
    Chester A. Chronic sinusitis. Am Fam Physician 1996;53: 877–87.PubMedGoogle Scholar
  19. 19.
    Lazar R, Younis R, Long T. Functional endonasal sinus surgery in adults and children. Laryngoscope 1993;103:1–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Willett L, Carson J., Williams J. Current diagnosis and management of sinusitis. J Gen Intern Med 1994;9:38–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Behrman R, Kliegman R. Nelson textbook of pediatrics. 14th ed. Philadelphia: Saunders, 1992:1059–61.Google Scholar
  22. 22.
    Garcia D, Merly SC, Loyce M. Radiographic imaging studies in pediatric chronic sinusitis. J Allergy Clin Immunol 1994; 94:523–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Diaz I, Bamberger D. Acute sinusitis. Semin Respir Infect 1995;10:14–20.PubMedGoogle Scholar
  24. 24.
    Mainous A, Hueston W, Clark J. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold? J Fam Pract 1996;42:357–61.PubMedGoogle Scholar
  25. 25.
    Pichichero M. Culture and antigen detection tests for streptococcal tonsillopharyngitis. Am Fam Physician 1992;45: 199–205.PubMedGoogle Scholar
  26. 26.
    O’Brien J, Meade J, Falk J. Dexamethasone as adjuvant therapy for severe acute pharyngitis. Ann Emerg Med 1993; 22:212–15.PubMedCrossRefGoogle Scholar
  27. 27.
    Miser W The content of outpatient family practice care in an Army community hospital: one physician’s three-year experience. Milit Med 1992;157:593–7.Google Scholar
  28. 28.
    Vukmir R. Adult and pediatric pharyngitis: a review. J Emerg Med 1992;10:607–16.PubMedCrossRefGoogle Scholar
  29. 29.
    Denny F. Tonsillopharyngitis 1994. Pediatr Rev 1994;15: 185–91.PubMedCrossRefGoogle Scholar
  30. 30.
    Pichichero M. Group A streptococcal tonsillopharyngitis: cost-effective diagnosis and treatment. Ann Emerg Med 1995;25:390–403.PubMedCrossRefGoogle Scholar
  31. 31.
    Pichichero M. Controversies in the treatment of streptococcal pharyngitis. Am Fam Physician 1990;42:1567–76.PubMedGoogle Scholar
  32. 32.
    Kiselica D. Group A beta-hemolytic streptococcal pharyngitis: current clinical concepts. Am Fam Physician 1994;49: 1147–54.PubMedGoogle Scholar
  33. 33.
    Glezen W, Clyde W, Senior R, Sheaffer C, Denny F. Group A streptococci, mycoplasmas, and viruses associated with acute pharyngitis. IAMA 1967;202:119–24.Google Scholar
  34. 34.
    Williams W, Williamson H, LeFevre M. The prevalence of Mycoplasma pneumoniae in ambulatory patients with non-streptococcal sore throat. Fam Med 1991;23:117–21.PubMedGoogle Scholar
  35. 35.
    Klein J. Management of streptococcal pharyngitis. Pediatr Infect Dis J 1994;13:572–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Pichichero M. Explanations and therapies for penicillin failure in streptococcal pharyngitis. Clin Pediatr 1992;31(11) Nov:642–9.CrossRefGoogle Scholar
  37. 37.
    Bonilla J, Bluestone C. Pharyngitis: when is aggressive treatment warranted? Postgrad Med 1995;97:61–2, 65–6, 68–9.Google Scholar
  38. 38.
    Centor R, Witherspoon J, Dalton H, et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1:240–6.CrossRefGoogle Scholar
  39. 39.
    Wegner D, Witte D, Schrantz R. Insensitivity of rapid antigen detection methods and single blood agar plate culture for diagnosing streptococcal pharyngitis. IAMA 1992;267: 695–7.CrossRefGoogle Scholar
  40. 40.
    Roddey O, Clegg H, Martin E, Swetenburg R, Koonce E. Comparison of an optical immunoassay technique with two culture methods for the detection of group A streptococci in a pediatric office. I Pediatr 1995;126:931–3.CrossRefGoogle Scholar
  41. 41.
    Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics 1995;96:758–64.PubMedGoogle Scholar
  42. 42.
    Kline J, Runge J. Streptococcal pharyngitis: a review of pathophysiology, diagnosis, and management. J Emerg Med 1994;12:665–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Fries S. Diagnosis of group A streptococcal pharyngitis in a private clinic: comparative evaluation of an optical immunoassay method and culture. J Pediatr 1995;126:933–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Shulman S. Complications of streptococcal pharyngitis. Pediatr Infect Dis J 1994;13:S70–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Patel K, Ahmad S, O’Leary G, Michel M. The role of computed tomography in the management of peritonsillar abscess. Otolaryngol Head Neck Surg 1992;107:727–32.PubMedGoogle Scholar
  46. 46.
    Epperly T, Wood T. New trends in the management of peritonsillar abscess. Am Fam Physician 1990;42:102–12.PubMedGoogle Scholar
  47. 47.
    Ahmed K, Jones A, Shah K, Smethurst A. The role of ultrasound in the management of peritonsillar abscess. J Laryn-gol Otol 1994;108:610–12.Google Scholar
  48. 48.
    Savolainen S, Jousimies-Somer H, Makitie A, Ylikoski J. Peritonsillar abscess: clinical and microbiologic aspects and treatment regimens. Arch Otolaryngol Head Neck Surg 1993;119: 521–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Chowdhury C, Bricknell M. The management of quinsy: a prospective study. J Laryngol Otol 1992;106:986–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Working Group on Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome. JAMA 1993; 269:390–1.CrossRefGoogle Scholar
  51. 51.
    Markowitz M. Changing epidemiology of group A streptococcal infections. Pediatr Infect Dis J 1994;13:557–60.PubMedCrossRefGoogle Scholar
  52. 52.
    Krober M, Bass J, Michels G. Streptococcal pharyngitis: placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA 1985;253:1271–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Snellman L, Stang H, Stang J, Johnson D, Kaplan E. Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics 1993;91:1166–70.PubMedGoogle Scholar
  54. 54.
    Holm S. Reasons for failures in penicillin treatment of streptococcal tonsillitis and possible alternatives. Pediatr Infect Dis J 1994;13:S66–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Paradise J. Etiology and management of pharyngitis and pharyngotonsillitis in children: a current review. Ann Otol Rhinol Laryngol 1992;101:51–7.Google Scholar
  56. 56.
    Coonan K, Kaplan E. In vitro susceptibility of recent North American group A streptococcal isolates to eleven oral antibiotics. Pediatr Infect Dis J 1994;13:630–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Slawson D, Squillace S, Franko J. Throat culture to rule out GABHS. J Fam Pract 1994;39:428.PubMedGoogle Scholar
  58. 58.
    Dippel D, Touw-Otten F, Habbema D. Management of children with acute pharyngitis: a decision analysis. J Fam Pract 1992;34:149–59.PubMedGoogle Scholar
  59. 59.
    Green S. Acute pharyngitis: the case for empiric antimicrobial therapy. Ann Emerg Med 1995;25:404–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Wilson K, Maroney S, Gander R. The family pet as an unlikely source of group A beta-hemolytic streptococcal infection in humans. Pediatr Infect Dis J 1995;14:372–5.PubMedCrossRefGoogle Scholar
  61. 61.
    Gerber M. Treatment failures and carriers: perception or problems? Pediatr Infect Dis J 1994;13:576–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Tanz R, Poncher J, Corydon K, Kabat K, Yogev R, Shulman S. Clindamycin treatment of chronic pharyngeal carriage of group A streptococci. J Pediatr 1991;119:123–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Paradise J, Blues tone C, Bachman R, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. N Engl J Med 1984;310:674–83.PubMedCrossRefGoogle Scholar
  64. 64.
    Pichichero M. Recurrent streptococcal pharyngitis: indications for tonsillectomy and penicillin prophylaxis. Pediatr Infect Dis J 1994;13:83–4.PubMedCrossRefGoogle Scholar
  65. 65.
    Deutsch E, Isaacson G. Tonsils and adenoids: an update. Pediatr Rev 1995;16:17–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Paul Evans
  • William F. Miser

There are no affiliations available

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