Abstract
Problems Rhinosinusitis (RS) is a common disease in Thailand and still has problems in the diagnosis and treatment. It is one of the most expensive diseases since a lot of investigations and antibiotics have been prescribed to treat this disease. It has also been shown to impair patients’ quality of life and, if not treated properly, may lead to orbital and/ or intracranial complication or development of chronic sinusitis. The data of this disease is quite limited in Thailand since it has not been studied systematically before. Objectives To investigate the natural history, clinical manifestations, practice variation of use of various instrument in the diagnosis, precipitating factors, the expense of investigation and treatment especially antibiotic, and complication of RS in Thailand. Methodology During April 2003 to May 2004, we performed a prospective study on 735 patients with acute (n=569) and subacute RS (n=43), recurrent acute RS (n=73), and acute exacerbation of chronic RS (n=47) recruited from Ear, Nose, and Throat (ENT) Department of 7 medical schools in Thailand. Results Seven hundred and thirty-five patients with RS were recruited in this study with the mean age of 34.1 years. The majority of patients’ age ranged from 20 to 50 years. There were 275 male (37.4%) and 460 female (62.6%). The average follow-up visits were 3 times. The most common clinical manifestations of RS are rhinorrhea (42.1%), followed by nasal congestion (38.6%), postnasal drip (32.3%), and facial pain (32.2%). ENT physicians used nasal speculum (91%), nasopharyngeal mirror (88%), otoscope (25%), and nasal endoscopy (11%) in the diagnosis of RS. Plain film paranasal sinus (PNS) and CT PNS were ordered in 17% and 1.6% of cases, respectively. Pus and/ or sinus tissues were sent for microbiological culture and sensitivity test in 30% of cases. The most common precipitating factors of RS is acute viral upper respiratory tract infection (62%). The majority of patients (98.6%) received medical treatment. Four percents of cases required surgical intervention. Complication was found in 11% of cases. Amoxicillin plus clavulanic acid is the most common antibiotic prescribed (31.5%), followed by amoxicillin (21.6%). Ninety-five percent of patients had favorable outcomes. Antibiotics account for the majority of the expense (74%) in the treatment of RS. Conclusion and recommendation Sinusitis is a costly disease, which needs more attention to reduce the cost of diagnosis and treatment. The Clinical Practice Guidelines (CPG) of diagnosis and treatment of RS have been developed recently. This CPG aimed to optimize the use of expensive and unnecessary investigation and to help physician in prescribing the proper treatment, either medical or surgical. The cost effectiveness of the practice according to these guidelines should be thoroughly studied before being implemented for nationwide use.
