February 11th 2015
Oral etidronate, IV pamidronate, and then zoledronate caused bone markers to normalize in this 80-year-old woman-temporarily. What’s going on? Answer this and questions on 3 other topics in this week’s quiz.
December 18th 2014
October 30th 2014
Acute Otitis Media: Update on Diagnosis and Antibiotic Choices
January 1st 2007Among American children,acute otitis media(AOM) is the most commonbacterial infectiontreated with antibiotics.Rising rates of antibacterial resistancecoupled with the increasingcost of antibiotics have focused attentionon the need to prescribethese agents judiciously. Recently,the American Academy of Pediatricsissued recommendations on the diagnosisand management of uncomplicatedAOM in children aged 2months to 12 years.1 These guidelinesapply only to otherwise healthychildren who have no underlyingconditions that may alter the naturalcourse of AOM, such as cleft palate,Down syndrome, immunodeficiencies,or the presence of cochlear implants.Also excluded are childrenwho have recurrent AOM or AOMwith underlying chronic otitis mediawith effusion (OME). Highlights ofthe guidelines are presented here.
Young Man With a History of Vague Headaches Ascribed to Sinusitis
January 1st 2007A 37-year-old man found unresponsiveat home with erratic respiration andurinary incontinence was brought tothe emergency department (ED). Accordingto his family, the patient hadbeen complaining of headaches, vertigo,and mild neck pain for 2 months.During that time, a CT scan of thesinuses revealed chronic sinusitis; thepatient had completed a course ofprednisone, naproxen, and meclizinewithout symptomatic improvement.The day before he was brought to theED, he had presented to a differenthospital with the same complaints andwas given a prescription for antibioticsfor a presumed sinus infection. He haddiet-controlled hypercholesterolemiaand did not smoke.
Observation Advised for Most Children with Acute Otitis Media
October 20th 2006UTRECHT, The Netherlands -- Reserve antibiotics for children younger than two years old with bilateral acute otitis media infections or for any child with otorrhea, researchers here recommended. For other children, watchful waiting seems justified
Exploring the link between nasal allergy and sinus infection
October 1st 2006Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)
Nasal Allergy and Sinus Infection:
October 1st 2006ABSTRACT: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis.
QUICK TAKE: When to consider allergy referral, part 2: Rhinitis and rhinosinusitis
September 1st 2006This year, the American Academy of Allergy, Asthma, and Immunology (AAAAI) published guidelines for referring patients to an allergist/immunologist.1 The AAAAI's recommendations for patients with asthma were summarized in the July 2006 issue of
Clinical Consultation: Allergic versus nonallergic rhinitis
July 1st 2006Patients with allergic rhinitis are genetically predisposed to producing specific IgE antibodies in response to environmental allergens, such as tree, grass, or ragweed pollen or cat, dog, or dust mite allergens. Patients must have symptoms suggestive of allergies and positive skin or serologic test results that correlate with their symptoms.
Clinical Consultation: Allergy testing in allergic rhinitis
June 1st 2006Allergy testing can be done any time that allergy is suspected, and it should be done if it is not clear whether the patient's symptoms are related to allergic or nonallergic causes. Seasonal allergies can often be controlled with medication--either a single medication or a combination. If this is possible, then allergy testing is not really necessary. The test results might be interesting to the patient and health care provider but would not change what they would do.
Clinical Citations: Allergic rhinitis, asthma, and atherosclerosis: Findings from 2 studies
February 1st 2006A number of inflammatory diseases have been associated with an increased risk of atherosclerosis. Knoflach and colleagues report findings that support a link between allergic diseases, such as allergic rhinitis and asthma, and atherosclerosis. Their findings came from 2 studies: the Bruneck study, which included 826 men and women aged 40 to 70 years, and the Atherosclerosis Risk Factors in Male Youngsters (ARMY) study, which included 141 male participants aged 17 or 18 years.
Indoor mold and your patient's health: From suspicion to confirmation
December 1st 2005Abstract: The manifestations of indoor mold-related disease (IMRD) include irritant effects, such as conjunctivitis and rhinitis; nonspecific respiratory complaints, such as cough and wheeze; hypersensitivity pneumonitis; allergic fungal sinusitis; and mycotoxicosis. The diagnosis of IMRD depends on eliciting an accurate history and excluding preexisting pathology that would account for the patient's symptoms. Laboratory tests, imaging studies, and spirometry can play an important role in ruling out other diagnoses, such as allergic or nonallergic rhinitis, asthma, and pneumonia. The diagnosis of IMRD also involves integrating the results of immunologic, physiologic, and imaging studies with the results of indoor air-quality studies. (J Respir Dis. 2005;26(12):520-525)
patient education guide Questions and Answers About Chronic Sinusitis
October 1st 2005These sinuses are lined by a membrane. When this membrane becomes inflamed--usually as a result of an infection or obstruction--you can get sinusitis. Sinusitis can be acute, recurrent, or chronic. Acute sinusitis responds well to treatment within a few weeks. Recurrent sinusitis is characterized by episodes that repeat at least 4 times a year. Sinusitis is considered to be chronic when symptoms persist for at least 12 weeks after treatment of acute sinusitis has ended.
Subdural Empyema Secondary to Sinusitis
September 14th 2005For 7 days, a 10-year-old boy had had a headache and a fever (temperature, 38.8°C [102°F]); a viral upper respiratory tract infection had been diagnosed. His parents brought him to the emergency department when weakness in his right leg developed, which impaired walking.
Clinical Consultation: Intranasal antifungals for sinusitis
May 1st 2005CRS is the most common chronic disease in the United States, affecting 17.4% of adults, with an estimated direct cost of $5.6 billion yearly.1,2 There frequently is no definitive or quick cure. The clinical diagnosis of CRS is based on the presence and persistence of certain symptoms. The finding of mucosal thickening on coronal CT scan of the paranasal sinuses strengthens the clinical diagnosis.
Getting allergic rhinitis under control: Part 2
May 1st 2005Most of the symptoms of allergic rhinitis, including nasal obstruction, rhinorrhea, sneezing, and nasal itching, respond to intranasal corticosteroids administered once or twice daily. However, many patients also need to take an antihistamine for adequate control of symptoms. While an antihistamine/decongestant combination can provide symptomatic relief, it fails to address the inflammatory component of allergic rhinitis. Thus, combining an intranasal corticosteroid or oral leukotriene modifier with an antihistamine might be a more effective strategy. Factors that can facilitate treatment adherence include minimizing the number of daily doses, allowing patients to select their own dosing schedules, and providing written instructions. Specific immunotherapy can be beneficial in select patients whose allergic rhinitis symptoms are not sufficiently controlled by pharmacotherapy. (J Respir Dis. 2005;26(5):188-194)
How to get your patient's allergic rhinitis under control
April 1st 2005Abstract: For some patients with allergic rhinitis, symptoms can be reduced substantially by the use of allergen avoidance measures. However, many patients require pharmacotherapy, including antihistamines, decongestants, and intranasal corticosteroids, to adequately control their symptoms. The oral antihistamines are effective in reducing rhinorrhea, itching, and sneezing but are not effective against nasal congestion. Intranasal azelastine has been shown to be beneficial in patients with moderate to severe symptoms that are not sufficiently controlled by an oral antihistamine. Additional therapies include intranasal ipratropium, which specifically targets rhinorrhea, and cromolyn, which can reduce many of the symptoms of allergic rhinitis and can be used prophylactically. (J Respir Dis. 2005;26(4):150-162)
Man With Chronic Eustachian Tube Dysfunction, Otitis Media, and Hearing Loss
September 1st 2003A 31-year-old man presents with a2-week history of a constant, dull acheand hearing loss in the right ear. Healso complains of intermittent sharppains that are usually followed bydrainage through the external auditorycanal. Another practitioner diagnosedacute otitis media with tympanic membraneperforation, for which he prescribeda 10-day course of amoxicillin.The patient completed the regimen buthas obtained no relief.