What is chronic sinusitis?
Inflammation of the paranasal sinuses lasting more than 12 weeks.
What pathogens cause chronic sinusitis?
- Staphylococcus aureus
- Gram-negative rods
- Haemophilus influenzae
- Group A streptococcus
- Streptococcus pneumoniae
What are the risk factors for chronic sinusitis?
- Ciliary dysfunction
- Aspirin sensitivity
- Allergic rhinitis
- Airway hyperreactivity/asthma
- Previous sinus injury
- Immunodeficiency
What are the signs of chronic sinusitis?
- N
What are the symptoms of chronic sinusitis?
- Facial pain and pressure
- Nasal obstruction
- Nasal discharge or post-nasal drip
- Purulence
- Headache
What investigations should be ordered for chronic sinusitis?
- Anterior rhinoscopy
- Nasal endoscopy
- Sinus CT
Why investigate using anterior rhinoscopy? And what may this show?
- Initial physical examination, both in primary care clinic and by specialist.
- Polyps, purulence from middle meatus or structural abnormalities may be seen.
Why investigate using nasal endoscopy? And what may this show?
- Performed by an ear, nose and throat physician in the clinic setting after nasal decongestion.
- Polyps, gross purulence or structural obstruction may be seen.
Why investigate using CT? And what may this show?
- CT scan without contrast confirms diagnosis. It should be ordered to confirm and stage chronic sinusitis in patients who fail maximal medical management.
- Opacification of involved sinuses, mucosal thickening, air-fluid levels or anatomical abnormalities.
Briefly describe the treatment for chronic sinusitis
- Nasal saline irrigation
- Intranasal corticosteroid
- Antibiotic therapy
- Decongestant
When is antibiotic therapy appropriate in treating chronic sinusitis?
- Oral antibiotics may be considered depending on examination/endoscopic findings, and response to initial treatment. If used, antibiotics should ideally be based on cultures.
- Evidence is limited.
What complications are associated with chronic sinusitis?
- Orbital cellulitis
- Intracranial infection
- Mucocele
- Decreased quality of life
What differentials should be considered in chronic sinusitis?
- Acute sinusitis
- Allergic rhinitis
- Allergic fungal sinusitis
- Sinonasal tumours
How does chronic sinusitis and acute sinusitis differ?
- Signs and symptoms: no symptoms or signs reliably differentiate acute from chronic sinusitis. Both present in a similar fashion, although symptoms are generally less pronounced in chronic sinusitis. The distinction between the 2 is based upon the duration of symptoms (≤4 weeks versus ≥12 weeks, respectively).
- Investigations: no differentiating tests.
How does chronic sinusitis and allergic rhinitis differ?
- Signs and symptoms: clear rhinorrhoea, itching, sneezing, ocular irritation and seasonality of symptoms suggest a predominant allergic component.
- Investigations:
How does chronic sinusitis and allergic fungal sinusitis differ?
- Signs and symptoms: similar symptoms; often unilateral.
- Investigations: CT scan shows hyperdensities within opacified sinuses.
How does chronic sinusitis and sinonasal tumours differ?
- Signs and symptoms: can occur in the sinuses, nasal cavity, or nasopharynx. Treatment for chronic sinusitis usually fails; symptoms are often unilateral and refractory. Constitutional symptoms may be present.
- Investigations: CT/MRI may show invasion or destruction of nearby structures that is suspicious for malignancy. Biopsy/tissue histology may reveal malignant cells.
