CHRONIC AND ACUTE RHINOSINUSITIS

Introduction

Rhinosinusitis is a medical condition characterized by inflammation of the nasal cavity and paranasal sinuses. It is a common condition that can be caused by a variety of factors, including infection, allergies, and anatomical abnormalities.

Sinus refers to a set of air-filled cavities located in various parts of the body, such as the facial bones, behind the nasal cavity, and above the eyes. The sinuses are lined with a mucous membrane, which produces mucus that helps to moisten and clean the inside of the nose.

The sinuses are important for several reasons, including:

• They help to lighten the weight of the skull and provide protection to the brain.
• They provide resonance to the voice.
• They play a role in regulating the temperature and humidity of the air we breathe.
• They produce mucus that helps to trap and clear bacteria, viruses, and other particles from the air we breathe.

Sinusitis is a common condition that occurs when the sinuses become inflamed and blocked, leading to symptoms such as facial pain, headache, nasal congestion, and thick nasal discharge. Treatment may include antibiotics, decongestants, nasal saline rinses, and in some cases, surgery.

Sinusitis is more specific and only refers to inflammation of the sinuses, rhinosinusitis includes both the nasal passages and sinuses.

There are several different classifications of rhinosinusitis, which are based on the duration and severity of the condition, as well as the underlying cause. The two main classifications are:

• Acute rhinosinusitis: This is a sudden onset of symptoms, typically lasting less than four weeks. It is usually caused by a bacterial or viral infection, and symptoms may include facial pain, nasal congestion, headache, and fever.
• Chronic rhinosinusitis: This is a long-term condition, lasting more than 12 weeks. It can be caused by a variety of factors, including allergies, infection, and anatomical abnormalities. Symptoms may include nasal congestion, postnasal drip, facial pain, and loss of sense of smell.

In addition to these two classifications, rhinosinusitis can also be further categorized based on the presence or absence of nasal polyps, which are small growths in the nasal cavity that can obstruct the sinuses. This includes:

• Chronic rhinosinusitis with nasal polyps: This is a subtype of chronic rhinosinusitis characterized by the presence of nasal polyps.
• Chronic rhinosinusitis without nasal polyps: This is a subtype of chronic rhinosinusitis where nasal polyps are not present.

 

Rhinosinusitis, commonly known as a sinus infection, is an inflammation of the nasal passages and sinuses. The condition can be caused by a variety of factors, including:

1. Viral infections: The common cold and flu are the most common viral infections that can lead to rhinosinusitis.
2. Bacterial infections: Bacterial infections can also cause rhinosinusitis, especially when the condition lasts for more than 10 days or when symptoms worsen after 5-7 days.
3. Fungal infections: Fungal infections are rare but can cause chronic rhinosinusitis, particularly in people with weakened immune systems.
4. Allergic reactions: Allergies to pollen, dust mites, or other environmental triggers can lead to inflammation of the nasal passages, which can lead to rhinosinusitis.
5. Anatomic abnormalities: Certain anatomical features such as a deviated septum, nasal polyps, or enlarged adenoids can obstruct the nasal passages and lead to rhinosinusitis.
6. Immune system disorders: People with immune system disorders such as HIV, diabetes, or cystic fibrosis are at a higher risk of developing rhinosinusitis.
7. Smoking: Smoking can irritate the nasal passages and increase the risk of developing rhinosinusitis.
8. Environmental factors: Exposure to pollutants or chemicals in the air, such as smoke or fumes, can irritate the nasal passages and sinuses and lead to rhinosinusitis.

In addition to these causes, certain predisposing factors can increase the risk of developing rhinosinusitis, including:

1. Age: Children under the age of 12 and adults over the age of 60 are more likely to develop rhinosinusitis.
2. Gender: Women are more likely to develop rhinosinusitis than men.
3. Chronic medical conditions: People with chronic medical conditions such as asthma or GERD are at a higher risk of developing rhinosinusitis.
4. Weakened immune system: People with weakened immune systems are more susceptible to developing rhinosinusitis.
5. Family history: A family history of rhinosinusitis or allergies may increase the risk of developing the condition.

It’s important to note that not everyone with these predisposing factors will develop rhinosinusitis, and many people without any of these factors can still develop the condition.

 

Here are some of the ways that rhinosinusitis can be diagnosed:

1. Medical history: A doctor will begin by asking the patient about their symptoms and medical history, including any recent respiratory infections or allergies.
2. Physical examination: A physical examination of the head and neck can provide clues to the presence of rhinosinusitis, such as swollen nasal tissues or tenderness over the sinuses.
3. Nasal endoscopy: A thin, flexible tube with a camera on the end can be inserted into the nasal passages to examine the sinuses and nasal tissues.
4. Imaging tests: Imaging tests such as X-rays, CT scans, or MRI scans can provide detailed images of the sinuses to help confirm a diagnosis of rhinosinusitis and rule out other possible causes of symptoms.
5. Allergy testing: Allergy testing may be done to determine if allergies are contributing to symptoms of rhinosinusitis.
6. Microbial testing: If symptoms are severe or persistent, a doctor may order microbial testing to identify the specific bacterial, viral, or fungal organisms that are causing the infection.

It’s important to see a doctor if you suspect you may have rhinosinusitis, as prompt treatment can help relieve symptoms and prevent complications.

 

The symptoms of rhinosinusitis can vary depending on the severity of the condition and the type of sinusitis, but typically include:

1. Facial pain and pressure: This is often felt in the cheeks, forehead, and around the eyes.
2. Nasal congestion: The nasal passages may become blocked, making it difficult to breathe through the nose.
3. Runny nose: The sinuses may produce excess mucus, which can drain out of the nose.
4. Headache: The pain may be located in the forehead or around the eyes, and it may worsen when bending over.
5. Fatigue: Sinusitis can cause a feeling of exhaustion and lack of energy.
6. Cough: This is more common with acute rhinosinusitis and may be worse at night.
7. Sore throat: Postnasal drip can cause irritation and inflammation of the throat.
8. Fever: A fever may be present with acute rhinosinusitis, but it is less common with chronic rhinosinusitis.

In addition to these symptoms, some people with rhinosinusitis may also experience toothache, bad breath, and a reduced sense of smell or taste. It is important to note that these symptoms can also be caused by other conditions, so it is important to seek medical advice if they persist.

 

Acute rhinosinusitis (ARS) is usually caused by a viral infection, while chronic rhinosinusitis (CRS) may be due to an infection or non-infectious causes such as allergies or structural abnormalities. Here are some ways to manage ARS and CRS:

Management of Acute Rhinosinusitis (ARS):

1. Pain relief: Pain and discomfort in ARS can be managed with over-the-counter pain medications such as paracetamol or ibuprofen.
2. Decongestants: Topical or oral decongestants can help reduce nasal congestion and improve breathing.
3. Saline nasal irrigation: Nasal saline irrigation can help relieve congestion, improve drainage, and reduce inflammation.
4. Antibiotics: If the cause of ARS is bacterial, antibiotics may be prescribed. However, antibiotics are not always necessary, and their overuse can lead to antibiotic resistance.
5. Steroids: Topical or oral steroids may be prescribed to reduce inflammation and relieve symptoms.

 

Management of Chronic Rhinosinusitis (CRS):

1. Nasal saline irrigation: Regular nasal saline irrigation can help reduce inflammation, improve drainage, and reduce symptoms.
2. Topical steroids: Topical steroids in the form of nasal sprays can help reduce inflammation and improve symptoms.
3. Oral steroids: In severe cases of CRS, oral steroids may be prescribed to reduce inflammation and symptoms.
4. Antibiotics: If the cause of CRS is bacterial, antibiotics may be prescribed. However, their use should be limited to cases where there is evidence of bacterial infection.
5. Immunotherapy: Immunotherapy may be used to manage CRS caused by allergies. It involves the administration of gradually increasing doses of allergen to help the body build immunity.
6. Surgery: In cases where other treatments have failed, surgery may be required to remove obstructions or correct structural abnormalities in the sinuses.

It is important to note that the management of rhinosinusitis should be tailored to the individual patient’s needs and based on the severity and cause of the condition. Consultation with an ENT specialist may be necessary for a proper evaluation and treatment plan.

 

The complications of rhinosinusitis and their management include:

1. Acute bacterial rhinosinusitis (ABRS): This is a bacterial infection of the nasal passages and sinuses that can lead to symptoms such as fever, facial pain, and thick nasal discharge. Treatment typically involves antibiotics, such as amoxicillin or doxycycline.
2. Chronic rhinosinusitis (CRS): This is a persistent inflammation of the nasal passages and sinuses that lasts for more than 12 weeks. Treatment may involve antibiotics, steroid nasal sprays, or surgery in severe cases.
3. Nasal polyps: These are noncancerous growths that develop in the lining of the nasal passages or sinuses, and can cause obstruction of the airway, leading to difficulty breathing. Treatment may involve steroid nasal sprays, oral steroids, or surgery to remove the polyps.
4. Orbital cellulitis: This is a serious complication of rhinosinusitis that occurs when the infection spreads to the tissues surrounding the eye. Treatment typically involves hospitalization, intravenous antibiotics, and sometimes surgery to drain the abscess.
5. Meningitis: This is a rare but serious complication of rhinosinusitis that occurs when the infection spreads to the membranes that surround the brain and spinal cord. Treatment involves hospitalization, intravenous antibiotics, and sometimes surgery to drain the abscess.
6. Osteomyelitis: This is a rare complication of rhinosinusitis that occurs when the infection spreads to the bone, causing inflammation and destruction of the bone tissue. Treatment may involve long-term antibiotic therapy, surgery to remove infected tissue, or a combination of both.
7. Brain abscess: This is a rare but potentially life-threatening complication of rhinosinusitis that occurs when the infection spreads to the brain, causing a collection of pus. Treatment involves hospitalization, intravenous antibiotics, and surgery to drain the abscess.

In summary, the complications of rhinosinusitis can range from mild to life-threatening, and their management depends on the severity of the infection and the specific complication involved. It is important to seek medical attention if you suspect you have a sinus infection, especially if you develop any of the above-mentioned complications.