Sinusitis

Definition | Acute Sinusitis | Chronic Sinusitis | Recurrent Acute Sinusitis | References

Definition

Sinusitis, also known as rhinosinusitis, is the inflammation of the mucous membranes lining the sinuses. It can be classified based on the duration and frequency of symptoms into acute, chronic, and recurrent acute sinusitis.

Acute Sinusitis

Definition: Acute sinusitis is an inflammation of the sinuses lasting less than 4 weeks.

Aetiology: Viral infections (e.g., common cold), bacterial infections (e.g., Streptococcus pneumoniae, Haemophilus influenzae), less commonly fungal infections.

Pathophysiology: Infection leads to inflammation and swelling of the sinus mucosa, causing obstruction of sinus drainage and accumulation of mucus.

Risk Factors: Upper respiratory infections, allergies, smoking, nasal polyps, anatomical variations (e.g., deviated septum).

Signs and Symptoms: Nasal congestion, purulent nasal discharge, facial pain or pressure, reduced sense of smell, fever, headache.

Investigations: Clinical history and physical examination, nasal endoscopy if needed, imaging (CT scan) in severe or recurrent cases.

Management:

• Rest and hydration
• Analgesics and antipyretics (e.g., paracetamol, ibuprofen)
• Intranasal corticosteroids (e.g., fluticasone, mometasone)
• Saline nasal irrigation
• Antibiotics if bacterial infection is suspected and symptoms are severe or not improving after 10 days (e.g., amoxicillin)
• Referral to an ENT specialist if symptoms persist or complications develop

Chronic Sinusitis

Definition: Chronic sinusitis is an inflammation of the sinuses lasting more than 12 weeks.

Aetiology: Persistent infection, chronic inflammation, allergies, nasal polyps, fungal infections.

Pathophysiology: Chronic inflammation leads to prolonged swelling of the sinus mucosa, obstruction of sinus drainage, and persistent symptoms.

Risk Factors: Allergies, asthma, smoking, nasal polyps, immunodeficiency, anatomical variations.

Signs and Symptoms: Nasal congestion, purulent nasal discharge, facial pain or pressure, reduced sense of smell, chronic cough, fatigue.

Investigations: Clinical history and physical examination, nasal endoscopy, CT scan of the sinuses.

Management:

• Intranasal corticosteroids (e.g., fluticasone, mometasone)
• Saline nasal irrigation
• Antibiotics for bacterial infections (e.g., doxycycline, levofloxacin)
• Oral corticosteroids for severe inflammation (short course)
• Surgery (e.g., functional endoscopic sinus surgery) for refractory cases
• Referral to an ENT specialist for persistent or severe cases

Recurrent Acute Sinusitis

Definition: Recurrent acute sinusitis is characterised by multiple episodes of acute sinusitis occurring within a year, with each episode lasting less than 4 weeks and separated by symptom-free periods.

Aetiology: Repeated viral or bacterial infections, allergies, anatomical variations, immune deficiencies.

Pathophysiology: Repeated infections lead to recurrent inflammation and swelling of the sinus mucosa, causing repeated obstruction and mucus accumulation.

Risk Factors: Allergies, asthma, smoking, frequent upper respiratory infections, nasal polyps, immunodeficiency.

Signs and Symptoms: Recurrent episodes of nasal congestion, purulent nasal discharge, facial pain or pressure, reduced sense of smell, fever during acute episodes.

Investigations: Clinical history and physical examination, nasal endoscopy, CT scan of the sinuses, allergy testing if allergic rhinitis is suspected.

Management:

• Management of acute episodes as per acute sinusitis
• Long-term intranasal corticosteroids (e.g., fluticasone, mometasone)
• Saline nasal irrigation
• Identification and management of underlying causes (e.g., allergies, anatomical issues)
• Referral to an ENT specialist for recurrent cases, consideration of surgical intervention if necessary

References

1. NICE. (2024). Sinusitis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Sinusitis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Sinusitis: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). (2021). Clinical Practice Guideline: Sinusitis. Retrieved from AAO-HNS

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