21. Acute and chronic rhinosinusitis

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)