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==Overview== | ==Overview== | ||
==Historical Perspective== | |||
==Classification== | |||
Rhinosinusitis can be classified based on the location of sinus involved, duration of the disease or etiology. | Rhinosinusitis can be classified based on the location of sinus involved, duration of the disease or etiology. | ||
==Pathophysiology== | |||
The pathophysiology for both acute and chronic rhinosinusitis involves blockage of the nasal sinuses and inflammation of the nasal sinuses. However, biofilms play a role in the pathogenesis of chronic rhinosinusitis. There are many associated conditions with rhinosinusitis, but most notably are those related to allergy and immunodeficiency. | The pathophysiology for both acute and chronic rhinosinusitis involves blockage of the nasal sinuses and inflammation of the nasal sinuses. However, biofilms play a role in the pathogenesis of chronic rhinosinusitis. There are many associated conditions with rhinosinusitis, but most notably are those related to allergy and immunodeficiency. | ||
==Causes== | |||
The causes of rhinosinusitis can be divided according to the infectious group that causes it into: bacterial, viral and fungal. | The causes of rhinosinusitis can be divided according to the infectious group that causes it into: bacterial, viral and fungal. | ||
==Differential Diagnosis== | |||
Rhinosinusitis must be differentiated from other diseases that may present with a headache and/or respiratory symptoms. | Rhinosinusitis must be differentiated from other diseases that may present with a headache and/or respiratory symptoms. | ||
==Epidemiology and Demographics== | |||
The incidence of acute rhinosinusitis and prevalence of chronic rhinosinusitis have a wide range, depending on the setting. | The incidence of acute rhinosinusitis and prevalence of chronic rhinosinusitis have a wide range, depending on the setting. | ||
==Risk Factors== | |||
Anatomical abnormalities of the nasal cavity, immunodeficiency and other diseases are all risk factors for the development of rhinosinusitis. | Anatomical abnormalities of the nasal cavity, immunodeficiency and other diseases are all risk factors for the development of rhinosinusitis. | ||
==Screening== | |||
There are no recommendations for screening for rhinosinusitis.<ref name="USPSTF sinusitis"> US Preventive Services Task Force (2016) https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=rhinosinusitis Accessed on September 28, 2016.</ref> | There are no recommendations for screening for rhinosinusitis.<ref name="USPSTF sinusitis"> US Preventive Services Task Force (2016) https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=rhinosinusitis Accessed on September 28, 2016.</ref> | ||
==Natural History, Complications and Prognosis== | |||
Acute rhinosinusitis is a self-limiting disease. However, rarely acute and chronic rhinosinusitis can be complicated by extension of the infection to the surrounding structures, such as the eyes and brain. | Acute rhinosinusitis is a self-limiting disease. However, rarely acute and chronic rhinosinusitis can be complicated by extension of the infection to the surrounding structures, such as the eyes and brain. | ||
==History and Symptoms== | |||
Rhinosinusitis can present with a wide range of constitutional and respiratory symptoms. | Rhinosinusitis can present with a wide range of constitutional and respiratory symptoms. | ||
==Physical Examination== | |||
Examination of the nose with a speculum or otoscope may reveal mucosal edema, narrowing of the middle meatus, purulent rhinorrhea and other findings. | Examination of the nose with a speculum or otoscope may reveal mucosal edema, narrowing of the middle meatus, purulent rhinorrhea and other findings. | ||
==Laboratory Findings== | |||
There are several lab findings that can be done when suspecting rhinosinusitis, but these findings are nonspecific. | There are several lab findings that can be done when suspecting rhinosinusitis, but these findings are nonspecific. | ||
==X-Ray== | |||
A plain [[x-ray]] of the sinuses has no role in the workup of rhinosinusitis. It may show a fluid level in the sinuses, but a plain [[x-ray]] is associated with a high negative and high positive rate for rhinosinusitis.<ref name="pmid15378314">{{cite journal |vauthors=Berger G, Steinberg DM, Popovtzer A, Ophir D |title=Endoscopy versus radiography for the diagnosis of acute bacterial rhinosinusitis |journal=Eur Arch Otorhinolaryngol |volume=262 |issue=5 |pages=416–22 |year=2005 |pmid=15378314 |doi=10.1007/s00405-004-0830-0 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |year=2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref> | A plain [[x-ray]] of the sinuses has no role in the workup of rhinosinusitis. It may show a fluid level in the sinuses, but a plain [[x-ray]] is associated with a high negative and high positive rate for rhinosinusitis.<ref name="pmid15378314">{{cite journal |vauthors=Berger G, Steinberg DM, Popovtzer A, Ophir D |title=Endoscopy versus radiography for the diagnosis of acute bacterial rhinosinusitis |journal=Eur Arch Otorhinolaryngol |volume=262 |issue=5 |pages=416–22 |year=2005 |pmid=15378314 |doi=10.1007/s00405-004-0830-0 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |year=2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref> | ||
==CT== | |||
Although not routinely indicated for suspected cases of rhinosinusitis and findings are highly nonspecific, CT scan is the imaging modality of choice in cases of chronic or complicated rhinosinusitis. Positive CT scan findings are not essential for diagnosis, but negative CT scan findings rules out rhinosinusitis. Findings include mucosal thickening and narrowing of the osteomeatal sinuses.<ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |year=2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid22438350">{{cite journal |vauthors=Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM |title=IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults |journal=Clin. Infect. Dis. |volume=54 |issue=8 |pages=e72–e112 |year=2012 |pmid=22438350 |doi=10.1093/cid/cir1043 |url=}}</ref><ref name="pmid20974374">{{cite journal |vauthors=Hoxworth JM, Glastonbury CM |title=Orbital and intracranial complications of acute sinusitis |journal=Neuroimaging Clin. N. Am. |volume=20 |issue=4 |pages=511–26 |year=2010 |pmid=20974374 |doi=10.1016/j.nic.2010.07.004 |url=}}</ref><ref name="pmid27602668">{{cite journal |vauthors=Rosenfeld RM |title=CLINICAL PRACTICE. Acute Sinusitis in Adults |journal=N. Engl. J. Med. |volume=375 |issue=10 |pages=962–70 |year=2016 |pmid=27602668 |doi=10.1056/NEJMcp1601749 |url=}}</ref> | Although not routinely indicated for suspected cases of rhinosinusitis and findings are highly nonspecific, CT scan is the imaging modality of choice in cases of chronic or complicated rhinosinusitis. Positive CT scan findings are not essential for diagnosis, but negative CT scan findings rules out rhinosinusitis. Findings include mucosal thickening and narrowing of the osteomeatal sinuses.<ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |year=2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid22438350">{{cite journal |vauthors=Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM |title=IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults |journal=Clin. Infect. Dis. |volume=54 |issue=8 |pages=e72–e112 |year=2012 |pmid=22438350 |doi=10.1093/cid/cir1043 |url=}}</ref><ref name="pmid20974374">{{cite journal |vauthors=Hoxworth JM, Glastonbury CM |title=Orbital and intracranial complications of acute sinusitis |journal=Neuroimaging Clin. N. Am. |volume=20 |issue=4 |pages=511–26 |year=2010 |pmid=20974374 |doi=10.1016/j.nic.2010.07.004 |url=}}</ref><ref name="pmid27602668">{{cite journal |vauthors=Rosenfeld RM |title=CLINICAL PRACTICE. Acute Sinusitis in Adults |journal=N. Engl. J. Med. |volume=375 |issue=10 |pages=962–70 |year=2016 |pmid=27602668 |doi=10.1056/NEJMcp1601749 |url=}}</ref> | ||
==Other Imaging Findings== | |||
==Other Diagnostic Studies== | |||
Nasal [[endoscopy]] and anterior rhinoscopy can be done in the case of rhinosinusitis to evaluate for nasal anatomy, [[nasal polyps]] and the paranasal [[sinuses]]. [[Endoscopy]] can be done as part of the functional endoscopic sinus surgery (FESS), which is used as a treatment in the case of chronic rhinosinusitis and [[nasal polyps]].<ref name="pmid27340637">{{cite journal |vauthors=K Maru Y, Gupta Y |title=Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases |journal=Indian J Otolaryngol Head Neck Surg |volume=68 |issue=2 |pages=202–6 |year=2016 |pmid=27340637 |doi=10.1007/s12070-014-0762-y |url=}}</ref><ref name="pmid27083059">{{cite journal |vauthors=Garcia GJ, Hariri BM, Patel RG, Rhee JS |title=The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area |journal=J Biomech |volume=49 |issue=9 |pages=1670–8 |year=2016 |pmid=27083059 |doi=10.1016/j.jbiomech.2016.03.051 |url=}}</ref> | Nasal [[endoscopy]] and anterior rhinoscopy can be done in the case of rhinosinusitis to evaluate for nasal anatomy, [[nasal polyps]] and the paranasal [[sinuses]]. [[Endoscopy]] can be done as part of the functional endoscopic sinus surgery (FESS), which is used as a treatment in the case of chronic rhinosinusitis and [[nasal polyps]].<ref name="pmid27340637">{{cite journal |vauthors=K Maru Y, Gupta Y |title=Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases |journal=Indian J Otolaryngol Head Neck Surg |volume=68 |issue=2 |pages=202–6 |year=2016 |pmid=27340637 |doi=10.1007/s12070-014-0762-y |url=}}</ref><ref name="pmid27083059">{{cite journal |vauthors=Garcia GJ, Hariri BM, Patel RG, Rhee JS |title=The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area |journal=J Biomech |volume=49 |issue=9 |pages=1670–8 |year=2016 |pmid=27083059 |doi=10.1016/j.jbiomech.2016.03.051 |url=}}</ref> | ||
==Medical Therapy== | |||
Supportive therapy is the mainstay of treatment for both cases of acute and chronic rhinosinusitis. Antibiotics can be added in select cases of acute, as well as chronic rhinosinusitis. | Supportive therapy is the mainstay of treatment for both cases of acute and chronic rhinosinusitis. Antibiotics can be added in select cases of acute, as well as chronic rhinosinusitis. | ||
==Surgery== | |||
Functional endoscopic sinus surgery (FESS) is reserved for cases of chronic rhinosinusitis not responding to medical therapy. | Functional endoscopic sinus surgery (FESS) is reserved for cases of chronic rhinosinusitis not responding to medical therapy. | ||
==Primary Prevention== | |||
There are no clear guidelines on how to prevent the occurrence of rhinosinusitis.<ref name="pmid25379119">{{cite journal |vauthors=Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, Jirapongsananuruk O, Kern R, Meltzer EO, Mullol J, Naclerio R, Pilan R, Rhee CS, Suzaki H, Voegels R, Blaiss M |title=ICON: chronic rhinosinusitis |journal=World Allergy Organ J |volume=7 |issue=1 |pages=25 |year=2014 |pmid=25379119 |pmc=4213581 |doi=10.1186/1939-4551-7-25 |url=}}</ref> | There are no clear guidelines on how to prevent the occurrence of rhinosinusitis.<ref name="pmid25379119">{{cite journal |vauthors=Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, Jirapongsananuruk O, Kern R, Meltzer EO, Mullol J, Naclerio R, Pilan R, Rhee CS, Suzaki H, Voegels R, Blaiss M |title=ICON: chronic rhinosinusitis |journal=World Allergy Organ J |volume=7 |issue=1 |pages=25 |year=2014 |pmid=25379119 |pmc=4213581 |doi=10.1186/1939-4551-7-25 |url=}}</ref> | ||
==Secondary Prevention== | |||
==References== | ==References== | ||
Revision as of 20:35, 3 October 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Historical Perspective
Classification
Rhinosinusitis can be classified based on the location of sinus involved, duration of the disease or etiology.
Pathophysiology
The pathophysiology for both acute and chronic rhinosinusitis involves blockage of the nasal sinuses and inflammation of the nasal sinuses. However, biofilms play a role in the pathogenesis of chronic rhinosinusitis. There are many associated conditions with rhinosinusitis, but most notably are those related to allergy and immunodeficiency.
Causes
The causes of rhinosinusitis can be divided according to the infectious group that causes it into: bacterial, viral and fungal.
Differential Diagnosis
Rhinosinusitis must be differentiated from other diseases that may present with a headache and/or respiratory symptoms.
Epidemiology and Demographics
The incidence of acute rhinosinusitis and prevalence of chronic rhinosinusitis have a wide range, depending on the setting.
Risk Factors
Anatomical abnormalities of the nasal cavity, immunodeficiency and other diseases are all risk factors for the development of rhinosinusitis.
Screening
There are no recommendations for screening for rhinosinusitis.[1]
Natural History, Complications and Prognosis
Acute rhinosinusitis is a self-limiting disease. However, rarely acute and chronic rhinosinusitis can be complicated by extension of the infection to the surrounding structures, such as the eyes and brain.
History and Symptoms
Rhinosinusitis can present with a wide range of constitutional and respiratory symptoms.
Physical Examination
Examination of the nose with a speculum or otoscope may reveal mucosal edema, narrowing of the middle meatus, purulent rhinorrhea and other findings.
Laboratory Findings
There are several lab findings that can be done when suspecting rhinosinusitis, but these findings are nonspecific.
X-Ray
A plain x-ray of the sinuses has no role in the workup of rhinosinusitis. It may show a fluid level in the sinuses, but a plain x-ray is associated with a high negative and high positive rate for rhinosinusitis.[2][3]
CT
Although not routinely indicated for suspected cases of rhinosinusitis and findings are highly nonspecific, CT scan is the imaging modality of choice in cases of chronic or complicated rhinosinusitis. Positive CT scan findings are not essential for diagnosis, but negative CT scan findings rules out rhinosinusitis. Findings include mucosal thickening and narrowing of the osteomeatal sinuses.[3][4][5][6]
Other Imaging Findings
Other Diagnostic Studies
Nasal endoscopy and anterior rhinoscopy can be done in the case of rhinosinusitis to evaluate for nasal anatomy, nasal polyps and the paranasal sinuses. Endoscopy can be done as part of the functional endoscopic sinus surgery (FESS), which is used as a treatment in the case of chronic rhinosinusitis and nasal polyps.[7][8]
Medical Therapy
Supportive therapy is the mainstay of treatment for both cases of acute and chronic rhinosinusitis. Antibiotics can be added in select cases of acute, as well as chronic rhinosinusitis.
Surgery
Functional endoscopic sinus surgery (FESS) is reserved for cases of chronic rhinosinusitis not responding to medical therapy.
Primary Prevention
There are no clear guidelines on how to prevent the occurrence of rhinosinusitis.[9]
Secondary Prevention
References
- ↑ US Preventive Services Task Force (2016) https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=rhinosinusitis Accessed on September 28, 2016.
- ↑ Berger G, Steinberg DM, Popovtzer A, Ophir D (2005). "Endoscopy versus radiography for the diagnosis of acute bacterial rhinosinusitis". Eur Arch Otorhinolaryngol. 262 (5): 416–22. doi:10.1007/s00405-004-0830-0. PMID 15378314.
- ↑ 3.0 3.1 Meltzer EO, Hamilos DL (2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
- ↑ Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin. Infect. Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.
- ↑ Hoxworth JM, Glastonbury CM (2010). "Orbital and intracranial complications of acute sinusitis". Neuroimaging Clin. N. Am. 20 (4): 511–26. doi:10.1016/j.nic.2010.07.004. PMID 20974374.
- ↑ Rosenfeld RM (2016). "CLINICAL PRACTICE. Acute Sinusitis in Adults". N. Engl. J. Med. 375 (10): 962–70. doi:10.1056/NEJMcp1601749. PMID 27602668.
- ↑ K Maru Y, Gupta Y (2016). "Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases". Indian J Otolaryngol Head Neck Surg. 68 (2): 202–6. doi:10.1007/s12070-014-0762-y. PMID 27340637.
- ↑ Garcia GJ, Hariri BM, Patel RG, Rhee JS (2016). "The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area". J Biomech. 49 (9): 1670–8. doi:10.1016/j.jbiomech.2016.03.051. PMID 27083059.
- ↑ Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, Jirapongsananuruk O, Kern R, Meltzer EO, Mullol J, Naclerio R, Pilan R, Rhee CS, Suzaki H, Voegels R, Blaiss M (2014). "ICON: chronic rhinosinusitis". World Allergy Organ J. 7 (1): 25. doi:10.1186/1939-4551-7-25. PMC 4213581. PMID 25379119.