- Acute sinusitis is a symptomatic inflammation of ≥1 paranasal sinuses of <4 weeks duration resulting from impaired drainage and retained secretions accompanied by obstruction, facial pain/pressure/fullness, or both. Because rhinitis and sinusitis usually coexist, “rhinosinusitis” is the preferred term.
- Disease is subacute when symptomatic 4 to 12 weeks, recurrent acute when ≥4 annual episodes without persistent symptoms in between, and chronic when symptomatic >12 weeks.
- Uncomplicated rhinosinusitis has no extension of inflammation beyond paranasal sinuses and nasal cavity.
- Affects 1 in 8 adults (>30 million people in the United States yearly diagnosed with rhinosinusitis)
- Acute bacterial rhinosinusitis remains the fifth leading reason for prescribing antibiotics.
- Viral cause in 90–98% of cases with 0.5–2% having a bacterial superinfection.
Incidence is highest in early fall through early spring (related to incidence of viral upper respiratory infection [URI]). Adults have 2 to 3 viral URIs per year; 90% of colds are accompanied by viral rhinosinusitis. It is the fifth most common diagnosis during family physician visits.
Etiology and Pathophysiology
- Important features
- Inflammation and edema of the sinus mucosa leads to obstruction of the sinus ostia causing impaired mucociliary clearance and stagnation of secretions that become hospitable to bacterial growth.
- Neutrophil influx and release of cytokines damages mucosal surfaces.
- Viral: majority of cases (rhinovirus; influenza A and B; parainfluenza; respiratory syncytial, adenoviruses, coronaviruses, and enteroviruses)
- Bacterial (complicates 0.5–2% of viral cases)
- More likely if symptoms worsen within 5 to 6 days after initial improvement
- No improvement within 10 days of symptom onset
- >3 to 4 days of fever >102°F and facial pain and purulent nasal discharge
- Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial pathogens.
- Overdiagnosis may lead to overuse of and increasing resistance to antibiotics.
- Methicillin-resistant Staphylococcus aureus present in 0–15.9% of patients
- Fungal: seen in immunocompromised hosts (uncontrolled diabetes, neutropenia, use of corticosteroids) or as a nosocomial infection; most common etiology is aspergillus.
- Viral URI
- Allergic rhinitis
- Cigarette smoking
- Dental infections and procedures
- Anatomic variations
- Tonsillar and adenoid hypertrophy
- Turbinate hypertrophy, nasal polyps
- Cleft palate
- Septal deviations
- Immunodeficiency (e.g., HIV)
- Cystic fibrosis (CF)
- Prolonged supine positioning (i.e., ICU patients)
Handwashing, vaccinations, avoiding symptomatic individuals, and avoiding smoking and exposure to secondhand smoke
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