Rhinosinusitis is commonly referred to as sinusitis. Here, we walk you through its classification, predisposing factors, pathophysiology, signs, symptoms, diagnosis, treatment, complications, and prognosis.

1. RHINOSINUSITIS
By Dr. Sarah D’souza
BDS
©

2. INTRODUCTION
Rhinosinusitis is the inflammation
of the paranasal sinuses due to
viral, bacterial, or fungal infections
or allergic reactions.

3. CLASSIFICATION
• Acute (completely resolved in < 30 days)
• Subacute (completely resolved in 30 to 90
days)
• Recurrent (≥ 4 discrete acute episodes per
year, each completely resolved in < 30 days but
recurring in cycles, with at least 10 days
between complete resolution of symptoms and
initiation of a new episode
• Chronic (lasting > 90 days)

4. PREDISPOSING FACTORS
• Dental infections & procedures
• Iatrogenic causes - Sinus surgery, nasal
packing, mechanical ventilation
• Immunodeficiency - HIV infection,
IG deficiencies
• Impaired ciliary motility - Smoking,
Cystic fibrosis, Immotile Cilia Syndome
• Mechanical obstruction - Deviated nasal
septum, nasal polyps, tumor, trauma
• Mucosal edema

5. PATHOPHYSIOLOGY
• In URI, the swollen nasal
mucous membrane obstructs
the ostium of a paranasal
sinus, and the oxygen in the
sinus is absorbed into the
blood vessels of the mucous
membrane.
• The resulting relative negative
pressure in the sinus (vacuum
sinusitis) is painful.

6. PATHOPHYSIOLOGY
• If the vacuum is maintained, a transudate from the
mucous membrane develops and fills the sinus; the
transudate serves as a medium for bacteria that enter
the sinus through the ostium or through a spreading
cellulitis or thrombophlebitis in the lamina propria of
the mucous membrane. An outpouring of serum and
leukocytes to combat the infection results, and painful
positive pressure develops in the obstructed sinus.
• The mucous membrane becomes hyperemic and
edematous.

7. SIGNS AND SYMPTOMS
• Purulent rhinorrhea
• Pressure and pain in the face
• Nasal congestion and obstruction
• Hyposmia
• Halitosis
• Productive cough (especially at night)
• The area over the affected sinus may be
tender, swollen, and erythematous.

8. • Maxillary sinusitis causes pain in the maxillary
area, toothache, and frontal headache.
• Frontal sinusitis causes pain in the frontal area
and frontal headache.
• Ethmoid sinusitis causes pain behind and
between the eyes, a frontal headache often
described as splitting, periorbital cellulitis, and
tearing
• Sphenoid sinusitis causes less well localized
pain referred to the frontal or occipital
area.Malaise may be present. Fever and chills
suggest an extension of the infection beyond
the sinuses.

9. DIAGNOSIS

10. TREATMENT
• Local measures to enhance drainage (eg, steam, topical
vasoconstrictors like phenylephrine 0.25% spray)
• Most cases of community-acquired acute sinusitis are
viral and resolve spontaneously, but sometimes we
may administer antibiotics (eg, amoxicillin/clavulanate,
doxycycline)
• Corticosteroid nasal sprays can help relieve symptoms
but typically take at least 10 days to be effective.

11. COMPLICATIONS
• Local spread of bacterial infection
• Periorbital or orbital cellulitis
• Cavernous sinus thrombosis
• Epidural or brain abscess.

12. PROGNOSIS
• Approximately 40% of acute sinusitis cases resolve
spontaneously without antibiotics.
• The spontaneous cure for viral sinusitis is 98%.
• Patients with acute sinusitis, when treated with
appropriate antibiotics, usually show prompt
improvement.
• The relapse rate after successful treatment is less than
5%.