Rhinosinusitis

 

Inflammation of the nasal passages and sinusitis – paranasal inflammation.

Etiology

  • a blockage at the ostia that drain the sinuses
  • viral upper respiratory tract infections
  • allergic rhinitis
  • Nasal polyps (constant irritant)
  • barotrauma due to changes in barometric pressure (damage)
  • abuse of nasal decongestants

 

Pathophysiology of the affected sinuses

  • The nasal cavities are continuous with the paranasal sinuses.
  • Upper respiratory tract infections frequently precede or occur in conjunction with sinus infections.

 

Manifestations

  1. facial pain
  2. purulent nasal discharge
  3. decreased sense of smell
  4. fever
  5. pain on bending
  6. unilateral maxillary pain

 

Diagnosis

  • Hx and Px of nose and throat
  • headache must be differentiated from other causes
  • differentiate between viral and bacterial rhinosinusitis
  • viral rhinosinusitis resolves within 7 days
  • bacterial rhinosinusitis may be present if symptoms worsen after 5-7 days or progress beyond 10 days
  • Immunocompromised individuals may present with fever, rhinorrhea, or facial edema, yet other signs may be absent
  • chronic rhinosinusitis may escalate to nasal obstruction, hoarseness and/or chronic cough

 

Treatment

  • antibiotics for secondary bacterial infection
  • mucolytic agents
  • symptom relief
  • 2/3rds of those with acute bacterial rhinosinusitis recover without antibiotics
  • Surgery may be used to correct obstructed ostiomeatal openings

 

Complications

  • due to sinus proximity to the brain and orbital wall, infections can lead to intracranial and orbital wall complications
  • seen most commonly with frontal and ethmoid sinus infections
  • Orbital complications can range from edema of the eyelids to orbital cellulitis and subperiosteal abscess formation

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