Rhinosinusitis

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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
- Cystic fibrosis
- Kartagener's Syndrome

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

Viral upper respiratory tract infection (common cold)
- Rhinovirus
Mucosal oedema of nose and paranasal sinuses
Bloackage of sinus drainage pathways
Stasis of mucosal secretions
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.