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UPPER RESPIRATORY TRACT INFECTIONS: VIRAL RHINOSINUSITIS

Wednesday, June 29th, 2011

Viral rhinosinusitis, otherwise known as the common cold, is a viral infection of the sinuses and nasal mucosa. Most adults have, on average, two to four infections each year, and children average six to eight of these infections annually. Transmission may occur through direct contactor by aerosol spread. The viral incubation time is typically 24 hours to 72 hours.Clinical features include nasal congestion and discharge, cough, headache, sneezing, and sore throat. General malaise is common, but more severe systemic symptoms are often minimal. High-grade fevers are rare and should raise suspicion of an alternative diagnosis. Symptoms typically last less than 7 days; however, up to 25% of patients may continue to be symptomatic at 14 days. Examination of the nasal mucosa reveals erythema and edema, often with prominent watery discharge. Other physical examination findings are scarce. When symptoms persist beyond 7 days, the clinician should begin to consider complications such as bronchitis, secondary bacterial sinusitis, or otitis media.Treatment of viral rhinosinusitis is supportive. There is no role for the use of antibiotics in this setting. Oral decongestants may be used (pseudoephedrine, 30 mg to 60 mg every 6 hours) to alleviate rhinorrhea and nasal congestion in otherwise healthy adults, and acetaminophen may be used to reduce fever, headache, and other systemic symptoms. Children should not be treated with aspirin, owing to concerns for the development of Reye’s syndrome. The oral decongestant phenylpropanolamine should not be used because of recent concerns of a small risk of hemorrhagic stroke associated with its use. Intranasal ipratropium bromide has been shown to reduce the severity of rhinorrhea.Many therapies for the common cold have been studied, with conflicting or confusing results. Zinc lozenges, vitamin C, and echinacea have all been studied for the treatment of the common cold. Data on the utility of these therapies are currently inconclusive. One study found that zinc was useful in reducing the length of symptoms, but side effects including bad taste and nausea, were common. A recent meta-analysis showed conflicting results. Based on available evidence, the use of zinc and echinacea is not recommended for the treatment of the common cold. Vitamin С may produce a little benefit in reducing cold symptoms but is not effective in preventing the onset of cold if taken daily.*34/348/5*

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