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Sinusitis

Sinusitis is an inflammation of the epithelium lining the paranasal sinuses and nasal cavities due to a bacterial, viral or fungal infection.


Presentation

Sinusitis presents as a blocked nose with postnasal discharge, headache, pain behind the eyes, in the cheeks, jaw and sometimes teeth, redness of the eyes and nose, watery eyes and sore throat with cough. There may be hyposmia and a feeling of pressure behind the face, particularly when bending forward. Sometimes the patient may also have a fever, muscular pain and halitosis (foul smelling breath).

Fever
  • "Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies.[ncbi.nlm.nih.gov]
  • Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.[mayoclinic.com]
  • You have a fever. You still have symptoms after taking all of your antibiotics properly. You have any changes in your vision during a sinus infection.[nlm.nih.gov]
  • Sinusitis Other names Sinus infection, rhinosinusitis A CT scan showing sinusitis of the ethmoid sinus Specialty Otorhinolaryngology Symptoms Thick nasal mucus, plugged nose, pain in the face, fever Sinusitis at Curlie[en.wikipedia.org]
Fatigue
  • The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis.[mayoclinic.com]
  • Fever, fatigue, a cough and bad breath are also possible. There are some home treatments you can try before seeing a doctor. Flushing your nose and sinuses with a saline solution can help.[wilx.com]
  • […] symptoms: Chronic sinus headaches /facial pressure in the forehead, eyes or cheeks Nasal congestion and/or difficulty breathing through the nose Runny nose or dripping from the back of the nose into the throat Loss of sense of smell or taste Chronic Fatigue[sinusinstituteatlanta.com]
  • Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip.[medlineplus.gov]
Fever of Unknown Origin
  • Nosocomial bacterial rhinosinusitis is an acute sinusitis that can affect patients in intensive care units (ICUs), typically presenting as fever of unknown origin.[cancertherapyadvisor.com]
  • Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients. Crit Care 2005 ;9: R583 –R590. Crossref, Medline, Google Scholar 117. Kronberg FG, Goodwin WJ.[atsjournals.org]
Cough
  • Children tend to be greatly affected by the presence of a very nasty sounding, and extremely persistent cough, this symptom tends to affect children even if the other known physical symptoms are absent, the continued persistence of such a cough may indicate[herbs2000.com]
  • Boodman, chicagotribune.com, "The girl who couldn't stop coughing," 5 Apr. 2018 But a sinus CT scan performed after Mimi had taken medications for two months still showed persistent sinusitis. — Sandra G.[merriam-webster.com]
  • Shah says if you or your child has a fever, cough, are wheezing or a decreased appetite, see a doctor for an evaluation. Dr. Shah is also seeing bronchitis, where patients get a barky cough, wheezing and chest tightness. Dr.[wkow.com]
  • In younger children: A runny nose that lasts longer than seven to 10 days Discharge is usually thick green or yellow, but can be clear Nighttime cough Occasional daytime cough Swelling around the eyes Usually no headaches younger than 5 years of age In[luriechildrens.org]
Rhinitis
  • CONCLUSION: Allergic rhinitis is common in childhood asthama, but sinusitis is rare.[ncbi.nlm.nih.gov]
  • Viral upper respiratory tract infection (URTI) and allergic rhinitis are risk factors for the development of secondary bacterial infection.[doi.org]
  • Allergic rhinitis and sinusitis are linked to each other, because allergic rhinitis causes your nose to become blocked, and in turn blocks the sinuses. Causes Allergic rhinitis is triggered by allergens.[who.int]
Common Cold
  • Sinusitis and allergy symptoms can happen at the same time as a common cold. If you are fighting off a cold and develop symptoms of a sinus infection or nasal allergy, see your healthcare provider.[my.clevelandclinic.org]
  • Computed tomographic study of the common cold .N Engl J Med. 1994 ;330: 25 - 30 Google Scholar Medline ISI Engels EA ,Terrin N ,Barza M.[doi.org]
  • Symptoms of acute sinusitis nearly resemble those of the common cold. In fact, the common cold is frequently a cause of acute sinusitis.[sinussurgeryprocedure.com]
  • It may be a short-term, acute inflammation caused by bacterial infection such as the common cold.[allergy.org.au]
  • Because your nose can get stuffy or congested when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold usually lasts about 7 to 14 days and goes away without treatment.[web.archive.org]
Nasal Congestion
  • However these sprays should be used only for 2 to 3 consecutive days because more prolonged use can cause rebound nasal congestion with increased symptoms.[nationaljewish.org]
  • Symptoms include: nasal congestion facial discomfort nasal discharge headache fatigue Types of Sinusitis There are two main categories of sinusitis: acute and chronic.[americansinus.com]
  • Because your nose can get stuffy or congested when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold usually lasts about 7 to 14 days and goes away without treatment.[web.archive.org]
Acute Cough
  • Acute cough who are older than 65 years of age with two of the following risk factors, or older than 80 years of age with one of the following risk factors: Hospitalisation in the previous year. Type 1 or type 2 diabetes. Congestive heart failure.[patient.info]
  • Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial .Br J Gen Pract. 1994 ;44: 400 - 4 Google Scholar Medline ISI Wald ER ,Chiponis D ,Ledesma-Medina J..[doi.org]
Halitosis
  • Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion.[ncbi.nlm.nih.gov]
  • […] swelling around your eyes, cheeks, nose or forehead Reduced sense of smell and taste in adults or cough in children Other signs and symptoms can include: Ear pain Aching in your upper jaw and teeth Cough that might worsen at night Sore throat Bad breath (halitosis[mayoclinic.com]
  • Symptoms of acute sinusitis include increased pressure in the sinuses, anosmia (loss of smell), worsening of nasal congestion, thick discolored nasal discharge, fatigue, development of fever, halitosis and pain in the teeth.[sinussurgeryprocedure.com]
  • Sometimes the patient may also have a fever, muscular pain and halitosis (foul smelling breath).[symptoma.com]
Jaw Pain
  • Hence, pathology here may be felt as upper jaw pain, toothache or pain in the skin of the cheek. This article will give you an overview of rhinosinusitis.[patient.info]
  • pain, ear pain, bad breath, and a cough that gets worse at night.[verywellhealth.com]
  • Infection in the maxillary sinuses can cause upper jaw pain and tooth sensitivity, with the malar areas tender to the touch.[web.archive.org]
Dental Abscess
  • Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Additionally, ciliary action can be affected after certain viral infections.[emedicine.medscape.com]
Angioedema
  • Battal Tahsin Somuk, Göksel Göktas, Samet Özer, Emrah Sapmaz and Yalcın Bas, Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis, International Journal of Pediatric Otorhinolaryngology, 82, (16), (2016). M.[doi.org]
Angioedema
  • Battal Tahsin Somuk, Göksel Göktas, Samet Özer, Emrah Sapmaz and Yalcın Bas, Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis, International Journal of Pediatric Otorhinolaryngology, 82, (16), (2016). M.[doi.org]
Otalgia
  • Minor factors (diagnostically significant only with one or more major factors) include a headache, halitosis, fatigue, malaise, dental pain, cough, and otalgia. A physical exam is best performed after a topical decongestant.[ncbi.nlm.nih.gov]
  • Not declared Not declared 12% (6/49) 3/6 in treatment group Tano 2004 108 0.9% saline spray versus no treatment Not declared Not declared 36% Only 60% compliance for most Tomooka 2000 211 Hypertonic irrigation 24% Nasal irritation, nasal discomfort, otalgia[doi.org]
Eye Pain
  • Pain and swelling are also common symptoms, especially under the eyes. Pain is usually worse on one side of the face.[raisingchildren.net.au]
  • The following are all common symptoms of sinusitis: A cold that lasts more than 10 days and is not getting better A headache with a feeling of pressure Pain and tenderness near your eyes and cheekbones, sometimes with swelling around your eyes Pain in[youngmenshealthsite.org]
  • Additional symptoms may include: facial tenderness; fever; tiredness; bad breath; headache; swelling around the eyes; pain in the upper jaw and/or teeth; cough; and nausea.[mydr.com.au]
Psychiatric Symptoms
  • CONCLUSIONS: Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study.[ncbi.nlm.nih.gov]
Sinus Pain
  • Decongestant may be prescribed to help drain the sinuses which may cause sinus pain or pressure. They are generally only recommended for short-term use.[nuh.com.sg]
  • Treating Related Symptoms of Bacterial Sinusitis Headache or sinus pain. To treat headache or sinus pain, try placing a warm washcloth on your child's face for a few minutes at a time.[healthychildren.org]
  • Sinusitis symptoms If your child has sinusitis, she might feel pressure or congestion over the area of an infected sinus. Pain and swelling are also common symptoms, especially under the eyes. Pain is usually worse on one side of the face.[raisingchildren.net.au]
  • Sinus pressure, sinus headache and sinus pain are commonly used terms to describe such discomfort. Sinus infection affects nearly 37 million Americans annually.[sinusinfectionhelp.com]
Facial Swelling
  • Symptoms of invasive fungal sinusitis People with invasive fungal sinusitis usually are very ill, and may have some of the following symptoms: Fever Facial pain or numbness Facial swelling Cough Nasal discharge Headache Mental status changes Dark ulcers[upmc.com]
  • On exam, look for facial swelling, erythema, edema (most commonly periorbital), cervical adenopathy, postnasal drainage or pharyngitis.[ncbi.nlm.nih.gov]
  • The early symptoms of sinusitis include Runny or stuffy nose, postnasal drip, earache, pain or pressure around the eyes or cheekbones, facial swelling, dizziness, headache, sore throat, fever, bad breath, tooth pain or sensitive, fatigue, cough, loss[emedicinehealth.com]
  • Refer for urgent ENT opinion if there are unilateral symptoms (eg, mass, bloodstained discharge, crusting, non-tender facial pain, facial swelling or unilateral nasal polyps ).[patient.info]
Neck Swelling
  • Tell your doctor if you develop bleeding from the nose, a stiff neck, swelling, or problems with your vision.[healthdirect.gov.au]
  • Notify your doctor promptly if your sinusitis gets worse with one or more of these warning symptoms: High fever Severe headache Mental confusion or stiff neck Swelling of the cheek, forehead, or roof of the mouth A swollen, red, painful eye Impaired vision[health.harvard.edu]
Headache
  • "Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies.[ncbi.nlm.nih.gov]
  • It includes painkillers for headache and facial pain, hot steam to open clogged up ostia and increased intake of warm fluids.[symptoma.com]
Trigeminal Neuralgia
  • Those somethings could be trigeminal migraines, trigeminal neuralgia, sluder's neuralgia, tension headaches, allergies, cold, etc. Assuming it is not neurologic, allergies are a common culprit.[fauquierent.net]
  • Causes of facial pain Migraine Trigeminal neuralgia Cluster headache Paroxysmal hemicrania Atypical facial pain Tension headache Chronic oro-facial pain Dental infection Mid-facial segment pain Post-herpetic neuralgia Primary care approach to CRS Treatment[racgp.org.au]
  • Yen‐Wen Lin, Shinn‐Kuang Lin and I‐Hsin Weng, Fatal Paranasal Sinusitis Presenting as Trigeminal Neuralgia, Headache: The Journal of Head and Face Pain, 46, 1, (174-178), (2006). Jonathan S. Glickstein, Rakesh K. Chandra and Jerome W.[doi.org]
Temporal Headache
  • Three months postprocedure, she presented with a 3-week history of gradual vision loss and constant temporal headache on the ipsilateral side.[ncbi.nlm.nih.gov]

Workup

Acute sinusitis is diagnosed clinically but its evaluation may include the following tests [7]:

  • Biopsy of paranasal sinuses
  • Nasal cytology
  • Testing for ciliary dysfunction
  • Complete blood count
  • ESR

Imaging 

Imaging studies are not required to diagnose sinusitis. In complicated cases, a CT scan and nasal endoscopy may be conducted.

Test results

Typically tests results are not awaited to confirm the diagnosis and start treatment because sinusitis is a clinical diagnosis. Nasal cytology may help identify the causative organism as viral or bacterial so that appropriate antibiotics or antivirals, respectively, may be prescribed.

Treatment

AVRS typically resolves within 10 days and ABRS may also resolve spontaneously within the first 10 days of infection, so patients who present with fewer than 10 days of symptoms in general should be managed with supportive care only [8]. It includes painkillers for headache and facial pain, hot steam to open clogged up ostia and increased intake of warm fluids. Antihistamines cause the sinuses to dry up but sometimes cause excessive drying, as well as have other side effects like drowsiness and xerostomia, so their use for the treatment of acute sinusitis is generally not recommended [9].

If the infection persists for more than a week or is very severe, mechanical irrigation with buffered hypertonic saline solution may help reduce the need for analgesics and improve overall patient comfort [10]. Irrigation is recommended for people suffering from frequent sinus infections.

Prognosis

Sinusitis has an excellent prognosis. Studies suggest that 40% to 69% of patients suffering from ABRS may clear their infection spontaneously [6]. Whatever the underlying cause, acute sinusitis persists for 3 to 10 days only and then resolves on its own. In some rare cases, it may progress to chronic sinusitis, which also has an excellent prognosis and is easily and effectively treated with antibiotics or antiviral drugs.

Etiology

Sinusitis may be due to a viral infection, such as infection from Rhinovirus, Adenovirus, Influenza virus A and B, Parainfluenza virus, Coronavirus or Respiratory syncytial virus resulting in acute viral rhinosinusitis (AVRS). It may also be caused by a bacterial infection, such as from Staphylococcus aureus, Staphylococcus pneumoniae, Haemophilus influenzae or Pseudomonas aeruginosa causing acute bacterial rhinosinusitis (ABRS). Acute viral upper respiratory tract infections are considered to be the most important risk factor for the development of ABRS [1].

Some fungi have also been implicated in the etiology of sinusitis but fungal sinusitis is a rare condition. Whatever the causative factor may be, the infection can be primary, affecting the paranasal sinuses directly, or it may be secondary, a result of an upper respiratory tract infection. The blocked sinuses have a negative sinus pressure and a reduced partial pressure of oxygen which makes the cavity ideal for the microorganisms to settle and multiply.

Chronic rhinosinusitis (CRS) is defined as an inflammatory condition involving the lining epithelium of the paranasal sinuses, which persists for at least 12 weeks or longer [2]. It is characterized by persistent nasal discharge or nasal blockage, headache and facial pain.

Epidemiology

Incidence

Sinusitis is an extremely common condition with an incidence of over 24 million cases every year in the United States [3].

Age

Sinusitis affects young and old alike. It does not have a predisposition to any particular age group.

Sex

It occurs equally in both sexes but infectious sinusitis is more common in females because they are more prone to close contact with children having infections.

Sex distribution
Age distribution

Pathophysiology

The paranasal sinuses develop as outpouchings of the nasal cavity, with the first sinuses appearing between the 3rd and 4th months of gestaton [4]. They are air-filled cavities extending from the skull to the alveolar process and are lined by pseudostratified ciliated columnar epithelium having mucus producing goblet cells. They include the frontal sinus, anterior and posterior ethmoid sinus, maxillary sinus and sphenoid sinus. All sinuses drain into the nasal cavity via openings called ostia. Ciliary activity is necessary for drainage of secretions from the sinuses into the nose, particularly from the maxillary sinus because the ostia are located high up on the medial walls of this sinus [5].

If any one or more of these paranasal sinuses become blocked and congested, the normally sterile mucus is prevented from draining into the nasal cavity via the ostia. The filling up of the sinuses with mucus results in negative sinus pressure which promotes the development of an infection. The viral, bacterial or fungal pathogens inhabit the congested sinuses and sinusitis develops. Some allergins such as pollen grains or animal fur may cause the sinuses to become irritated resulting in excessive mucus production which then blocks up the cavities causing sinusitis.

Prevention

Sinusitis may be prevented by intake of appropriate fluids and good oral hygiene. Upper respiratory tract infections should be promptly and properly treated

Summary

Sinusitis, or more appropriately rhinosinusitis, is the inflammation of the mucosa of the paranasal sinuses which presents as features similar to influenza. It is a common household occurrence and affects people of all ages, races and ethnicity. Paranasal sinues are hollow bony cavities that help reduce the weight of the skull as well as humidify air during respiration. If any of these sinuses become blocked, the mucus produced by the goblet cells present in these sinuses is unable to drain out, the nasal cavity becomes congested and sinusitis ensues. Commonly, the condition is due to external pathogens, as discussed below.

Patient Information

Definition

Sinusitis is a condition in which the lining membrane of paranasal sinuses, which are hollow air-filled cavities present in the skull, become infected and congested with mucus.

Cause

Sinusitis may be viral, bacterial or fungal or it may be due to an upper respiratory tract infection. Sometimes allergens like pollen grains and animal fur may cause overproduction of mucus which may become infected resulting in sinusitis.

Signs and symptoms

It presents with a blocked and congested nose, thick, postnasal discharge, headache, pain behind the eyes, in the jaws and teeth, red watery eyes and fever. There may also be sore throat and cough.

Diagnosis

Diagnosis of sinusitis is purely clinical. Laboratory tests may help in identifying the causative agent.

Treatment

Treatment is mainly supportive as most cases of sinusitis resolve by themselves. However, it may be treated with antibiotics or antiviral drugs.

References

Article

  1. Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. Jun 2007;119(6):e1408-12 
  2. Slavin RG, Spector SL, Bernstein IL, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005; 116:S13.
  3. Anon JB. Upper respiratory infections. Am. J. Med, Apr 2010. 123 (4 Suppl): S16–25. 
  4. Cherry JD, Mundi J, Shapiro NL. Rhinosinusitis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrision GJ, Kaplan SL, et al. (Eds), Elsevier Saunders, Philadelphia 2014. p.193.
  5. Wald ER. Rhinitis and acute and chronic sinusitis. In: Pediatric Otolaryngology, 2nd, Bluestone CD, Stool SE, Sheetz MD (Eds), Saunders, Philadelphia 1990. p.729.
  6. Falagas ME, Giannopoulou KP, Vardakas KZ, et al. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. Lancet Infect Dis 2008; 8:543. 
  7. Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. Dec 2005;116(6 Suppl):S13-47
  8. Tan T, Little P, Stokes T, Guideline Development Group. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ 2008; 337:a437.
  9. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.
  10. Kassel JC, King D, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2010; :CD006821.

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Last updated: 2019-07-11 22:40