21. Acute and chronic rhinosinusitis

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  • Sinusitis rarely occurs without rhinitis – rhinosinusitis
  • Pansinusitis – all sinuses
  • Acute rhinosinusitis
    • < 4 weeks
    • Maxillary sinus > ethmoidal cells
    • Etiology
      • Spread of rhinitis
      • Viruses
        • Rhinovirus
        • Coronavirus
      • Bacteria
        • S. pneumoniae
        • H. influenzae
      • Spread of dental root infection
    • Clinical features
      • Symptoms of rhinitis
      • Pain over sinus
      • Headache – worsens when bending over
    • Diagnosis
      • Rhinoscopy/endoscopy – pus, swollen mucosa
      • Sinus radiography – partial opacification of affected sinus or fluid level
    • Treatment
      • Conservative
        • Ventilation, drainage improvement
          • Decongestants
        • Antibiotics
      • Surgery
        • Puncture of wall


  • Chronic rhinosinusitis
    • > 12 weeks
    • Etiology
      • Impaired ventilation due to obstruction
      • Anatomical abnormalities
        • Septal deviation
        • Septal spur
      • Untreated acute rhinosinusitis
      • Chronic allergy
    • Clinical features (4 major signs, 4 minor)
      • 4 major signs
        • Nasal obstruction
        • Purulent nasal discharge (ant/post)
        • Anosmia
        • Facial pain
      • 4 minor signs
        • Cough
        • Dental pain
        • Fever
        • Halitosis
    • Diagnosis
      • Rhinoscopy/endoscopy
      • CT
    • Treatment
      • Conservative (symptomatic)
        • Decongestants
        • Antibiotics
      • Functional endoscopic sinus surgery (FESS) (definitive)