Rhinosinusitis

Overview

Overview Rhinosinusitis is one of the more prevalent chronic illnesses worldwide, affecting individuals of all ages. It is an inflammatory process that involves the nose and paranasal sinuses. Rhinosinusitis may be acute or chronic. Chronic rhinosinusitis can be subject to acute exacerbations.

Definition
Rhinitis: Irritation and inflammation of the mucosa lining the nasal cavity
Sinusitis: Inflammation of the sinuses (usually a result of rhinitis)
Acute rhinosinusitis: Acute inflammatory condition of the nose and paranasal sinuses

Sinus Anatomy

Risk Factors

  • Allergy and Atopy
  • Septal deviation
  • Mechanical obstruction of sinus
    • Tumours
    • Foreign bodies
  • History of chronic sinusitis
  • Conditions affecting mucociliary clearence
Kartagener's Syndrome also known as primary ciliary dyskinesia  is a rare, ciliopathic, autosomal recessive genetic disorder that causes defects in the action of cilia lining the respiratory tract

Signs and Symptoms

Clinical Presentation - Acute rhinosinusitis

  • Prurulent rhinorrhoea
  • Nasal congestion and stuffiness
  • Facial pain and/or pressure
  • Hyposmia or altered taste
  • Dental pain

Clinical Presentation - Chronic rhinosinusitis

  • Rhinorrhoea
  • Nasal congestion and stuffiness
  • Post-nasal drip
  • Facial pain or pressure
  • Hyposmia or altered taste
  • Dry or sore throat
  • Halitosis
  • Sneezing
  • Itchy or runny eyes
  • Blocked ears
  • General malaise

Clinical Examination

  • Nasal mucosal inflammation
  • Nasal polyps
  • Mucopurulent secretions
  • Conchae (Turbinate) hypertrophy
  • Other anatomic abnormalities (nasal septal deviation causing obstruction)

Pathophysiology

Acute rhinosinusitis

  1. Viral upper respiratory tract infection (common cold)
    • Rhinovirus
  2. Mucosal oedema of nose and paranasal sinuses
  3. Bloackage of sinus drainage pathways
  4. Stasis of mucosal secretions
  5. Secondary bacterial infection (pyogenic organisms)
    • Streptococ­cus pneumoniae
    • Haemophilus influenzae
    • Moraxella catarrhalis.

Chronic rhinosinusitis

Stasis of secretion results in cessation of bacterial export, propagating mucosal inflammation and compromising aeration of the mucosa. This in turn leads to increased ciliary dysfunction and the vicious cycle continues, resulting in CRS.

Management

Acute rhinosinusitis

  • Analgesics (topical or oral)
  • Decongestants (topical or oral)
  • Antibiotics (penicillins)
  • Surgery

Chronic rhinosinusitis

  • Analgesics (topical or oral)
  • Decongestants (topical or oral)
  • Steroids (topical or oral
  • Antihistamines
  • Antibiotics (penicillins)
  • Allergy testing - if allergy trigger is suspected
  • Surgery
    • Functional endoscopic sinus surgery (FESS)

Complications and Prognosis

Complications

Frontal sinusitis

  • Osteomyelitis
    • Pott's puffy tumour
  • Extradural abscess
  • Subdural abscess
  • Meningitis
  • Frontal lobe abscess

Ethmoid sinusitis

  • Periorbital cellulitis
  • Orbital abscess

Maxillary sinusitis

Sphenoid sinusitis

Prognosis Acute rhinosinusitis is very common and most cases resolve without any long-term sequelae.