Sinusitis (Rhinosinusitis)
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Basics
Description
- Inflammation of mucous membranes lining the paranasal sinuses and nasal passages with or without fluid collection in the sinus cavities
- Classifications:
- Acute: Signs and symptoms for <4 wk
- Subacute: Signs and symptoms for 4–8 wk
- Chronic: Signs and symptoms for >8 wk in spite of antibiotic treatment
- Recurrent: 3 or more episodes per year
Etiology
- Acute rhinosinusitis pathophysiology:
- Viral upper respiratory infection or allergies causes mucous membrane inflammation
- Inflammation causes obstruction of sinus ostia, decreased mucociliary clearance, and thickening of secretions
- Viruses are the primary cause, but 0.5–2.2% develop into bacterial infection after bacteria become trapped and multiply, resulting in suppuration
- Nosocomial rhinosinusitis associated with nasogastric and nasotracheal tubes
- Immunocompromised patients at higher risk for rhinosinusitis
- Subacute and chronic rhinosinusitis pathophysiology:
- Multifactorial, role of bacteria remains elusive
- Allergic inflammation causing narrowed ostia and blocked drainage
- Immune dysfunction leading to increased infectious risk
- Impaired ciliary function leading to decreased mucous clearance
- Odontogenic infection causing maxillary sinusitis
- Fungus ball
- Anatomical obstruction or polyps obstructing sinus ostia
- Microbiology:
- Acute rhinosinusitis:
- Nontypable Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Staphylococcus aureus
- Anaerobes
- Viruses:
- Parainfluenza
- Adenovirus
- Rhinovirus
- Influenza
- Chronic rhinosinusitis:
- Same as acute, often polymicrobial, with increasing anaerobes and gram negatives
- Nosocomial rhinosinusitis:
- S. aureus
- Streptococcal species
- Pseudomonas
- Klebsiella
- Immunocompromised patients with rhinosinusitis:
- Bacteria as above
- Fungal pathogens
- Aspergillus
- Mucormycosis
- Acute rhinosinusitis:
Pediatric Considerations
- Nontypable H. influenzae more common than S. pneumoniae as cause of acute bacterial rhinosinusitis in children
- Ethmoid and maxillary sinuses present at birth
- Sphenoid sinuses develop ∼5 yr and frontal sinuses develop ∼7 yr
- Rhinosinusitis more common in children
- Periorbital/orbital cellulitis is a common complication of ethmoid rhinosinusitis in children:
- Periorbital swelling, fever, ptosis, proptosis, and painful or decreased extraocular movements
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Basics
Description
- Inflammation of mucous membranes lining the paranasal sinuses and nasal passages with or without fluid collection in the sinus cavities
- Classifications:
- Acute: Signs and symptoms for <4 wk
- Subacute: Signs and symptoms for 4–8 wk
- Chronic: Signs and symptoms for >8 wk in spite of antibiotic treatment
- Recurrent: 3 or more episodes per year
Etiology
- Acute rhinosinusitis pathophysiology:
- Viral upper respiratory infection or allergies causes mucous membrane inflammation
- Inflammation causes obstruction of sinus ostia, decreased mucociliary clearance, and thickening of secretions
- Viruses are the primary cause, but 0.5–2.2% develop into bacterial infection after bacteria become trapped and multiply, resulting in suppuration
- Nosocomial rhinosinusitis associated with nasogastric and nasotracheal tubes
- Immunocompromised patients at higher risk for rhinosinusitis
- Subacute and chronic rhinosinusitis pathophysiology:
- Multifactorial, role of bacteria remains elusive
- Allergic inflammation causing narrowed ostia and blocked drainage
- Immune dysfunction leading to increased infectious risk
- Impaired ciliary function leading to decreased mucous clearance
- Odontogenic infection causing maxillary sinusitis
- Fungus ball
- Anatomical obstruction or polyps obstructing sinus ostia
- Microbiology:
- Acute rhinosinusitis:
- Nontypable Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Staphylococcus aureus
- Anaerobes
- Viruses:
- Parainfluenza
- Adenovirus
- Rhinovirus
- Influenza
- Chronic rhinosinusitis:
- Same as acute, often polymicrobial, with increasing anaerobes and gram negatives
- Nosocomial rhinosinusitis:
- S. aureus
- Streptococcal species
- Pseudomonas
- Klebsiella
- Immunocompromised patients with rhinosinusitis:
- Bacteria as above
- Fungal pathogens
- Aspergillus
- Mucormycosis
- Acute rhinosinusitis:
Pediatric Considerations
- Nontypable H. influenzae more common than S. pneumoniae as cause of acute bacterial rhinosinusitis in children
- Ethmoid and maxillary sinuses present at birth
- Sphenoid sinuses develop ∼5 yr and frontal sinuses develop ∼7 yr
- Rhinosinusitis more common in children
- Periorbital/orbital cellulitis is a common complication of ethmoid rhinosinusitis in children:
- Periorbital swelling, fever, ptosis, proptosis, and painful or decreased extraocular movements
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