Evaluaton of Patients With Recurrent or Persistent Sinusitis

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Fifty percent of children and 30-40% of adults with recurrent or chronic sinusitis are sensitized to common aeroallergens such as plant pollens, house dust mite, and animal danders. Assessment of IgE-mediated hypersensitivities by allergy skin testing or in vitro blood assays should therefore be performed in all patients because they may benefit from a comprehensive program of allergen avoidance, anti-allergic drug therapy, and, in selected cases, immunotherapy. Patients with severe, recurrent episodes of sinusitis associated with other infections (e.g., otitis, bronchitis, and pneumonia) may suffer from one of the antibody deficiency syndromes and should undergo a screening assessment of their immunoglobulin levels. If a deficiency is noted or still suspected after the initial testing, these patients should be referred to an allergist/immunologist for further evaluation.

Table 6

Factors Associated With Otitis Media

Acute viral upper respiratory infection

Chronic rhinitis

Exposure to tobacco smoke

Adenoidal hypertrophy

Variants of eustachian tube anatomy

Cleft palate disease

Down syndrome

Ciliary dyskinesia syndrome

Humoral immunodeficiency

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