Sinusitis

Source: Wikipedia, the free encyclopedia.
For the joint inflammation condition, see Synovitis.
Sinusitis
Other namesSinus infection, rhinosinusitis
nasal steroids, nasal irrigation, antibiotic[1][6]
Frequency10–30% each year (developed world)[1][7]

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain.[1][8]

Sinusitis usually occurs in individuals with underlying conditions

computed tomography.[1]

Some cases may be prevented by hand washing,

amoxicillin/clavulanate being superior to amoxicillin alone but with more side effects.[11][1] Surgery may occasionally be used in people with chronic disease[12] or in someone who is not responding to medicines as per doctor's expectation.[13][unreliable medical source?
]

Sinusitis is a common condition.[1] It affects between about 10 and 30 percent of people each year in the United States and Europe.[1][7] Chronic sinusitis affects about 12.5% of people.[14] Treatment of sinusitis in the United States results in more than US$11 billion in costs.[1] The unnecessary and ineffective treatment of viral sinusitis with antibiotics is common.[1]

Signs and symptoms

Headache, facial pain, or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. This pain is usually localized to the involved sinus and may worsen when the affected person bends over or lies down. Pain often starts on one side of the head and progresses to both sides.[15] Acute sinusitis may be accompanied by a thick nasal discharge that is usually green in color, and may contain pus or blood.[16] Often, a localized headache or toothache is present, and these symptoms distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches. Another way to distinguish between toothache and sinusitis is that the pain in sinusitis is usually worsened by tilting the head forward and with the Valsalva maneuver.[17]

Other symptoms associated with acute rhinosinusitis include cough, fatigue, hyposmia, anosmia and ear fullness or pressure.[18]

Sinus infections can also cause middle-ear problems due to the congestion of the nasal passages. This can be demonstrated by dizziness, "a pressurized or heavy head", or vibrating sensations in the head.

Postnasal drip is also a symptom of chronic rhinosinusitis.[19]

Halitosis (bad breath) is often stated to be a symptom of chronic rhinosinusitis; however, gold-standard breath analysis techniques[clarification needed] have not been applied. Theoretically, several possible mechanisms of both objective and subjective halitosis may be involved.[17]

A 2005 review suggested that most "sinus headaches" are migraines.

trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.[21]

Symptoms of

smell.[22]

By location

The four paired paranasal sinuses are the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinuses are further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle nasal concha. In addition to the severity of disease, discussed below, sinusitis can be classified by the sinus cavity it affects:

  • Maxillary – can cause pain or pressure in the maxillary (cheek) area (e.g., toothache,[17] or headache) (J01.0/J32.0)
  • Frontal – can cause pain or pressure in the frontal sinus cavity (located above the eyes), headache, particularly in the forehead (J01.1/J32.1)
  • Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches (J01.2/J32.2)[23]
  • mastoid processes, or the back of the head.[23]

Complications

Chandler Classification
Stage Description
I Preseptal cellulitis
II Orbital cellulitis
III Subperiosteal abscess
IV Orbital abscess
V Cavernous sinus septic thrombosis

Complications are thought to be rare (1 case per 10,000).[24]

The proximity of the brain to the sinuses makes the most dangerous complication of sinusitis, particularly involving the frontal and sphenoid sinuses, infection of the brain by the invasion of

Abscesses, meningitis, and other life-threatening conditions may result. In extreme cases, the patient may experience mild personality changes, headache, altered consciousness, visual problems, seizures, coma, and possibly death.[15]

Sinus infection can spread through

ethmoid labyrinth. Sinusitis may extend to the central nervous system, where it may cause cavernous sinus thrombosis, retrograde meningitis, and epidural, subdural, and brain abscesses.[26] Orbital symptoms frequently precede intracranial spread of the infection . Other complications include sinobronchitis, maxillary osteomyelitis, and frontal bone osteomyelitis.[27][28][29][30] Osteomyelitis of the frontal bone often originates from a spreading thrombophlebitis. A periostitis of the frontal sinus causes an osteitis and a periostitis of the outer membrane, which produces a tender, puffy swelling of the forehead.[citation needed
]

The diagnosis of these complications can be assisted by noting local tenderness and dull pain, and can be confirmed by

parenteral antimicrobial therapy.[31] Chronic sinus infections may lead to mouth breathing, which can result in mouth dryness and an increased risk of gingivitis. Decongestants may also cause mouth dryness.[32]

If an odontogenic infection or a complication of a dentistry procedure involves the maxillary sinus, odontogenic sinusitis (ODS) may ensue.[33] Odontogenic sinusitis can often spread to other sinuses such as the ethmoid, frontal and (less frequently) sphenoid sinus, and even to the contralateral nasal cavity.[34] In rare instances, these infections may involve the orbit, causing orbital cellulitis, which may in turn result in blindness, or determine central nervous system complications such as meningitis, subdural empyema, brain abscess and life-threatening cavernous sinus thrombosis.[35][36]

Infection of the eye socket is a rare complication of ethmoid sinusitis, which may result in the loss of sight and is accompanied by fever and severe illness. Another possible complication is the infection of the bones (osteomyelitis) of the forehead and other facial bones – Pott's puffy tumor.[15]

Voice box can also get infected resulting in laryngitis.[4][unreliable medical source?] This can result in hoarseness, change in voice, pain in throat, pain while talking, inaudible voice, dry cough and fever.[4][unreliable medical source?]

Causes

Acute

Gram-negative bacteria. Viral sinusitis typically lasts for 7 to 10 days.[24]

transplant on immunosuppressive antirejection medications) and can be life-threatening. In type I diabetics, ketoacidosis can be associated with sinusitis due to mucormycosis.[38]

Chronic

By definition, chronic sinusitis lasts longer than 12 weeks and can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. It is subdivided into cases with and without

hyperplastic sinusitis; however, the causes are poorly understood.[24] It may develop with anatomic derangements, including deviation of the nasal septum and the presence of concha bullosa (pneumatization of the middle concha) that inhibit the outflow of mucus, or with allergic rhinitis, asthma, cystic fibrosis, and dental infections.[39]

Chronic rhinosinusitis represents a multifactorial inflammatory disorder, rather than simply a persistent bacterial infection.[24] The medical management of chronic rhinosinusitis is now focused upon controlling the inflammation that predisposes people to obstruction, reducing the incidence of infections.[40] Surgery may be needed if medications are not working.[40]

Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. The presence of

eosinophils in the mucous lining of the nose and paranasal sinuses has been demonstrated for many people, and this has been termed eosinophilic mucin rhinosinusitis (EMRS). Cases of EMRS may be related to an allergic response, but allergy is not often documented, resulting in further subcategorization into allergic and nonallergic EMRS.[41]

A more recent, and still debated, development in chronic sinusitis is the role that

fungi play in this disease.[42] Whether fungi are a definite factor in the development of chronic sinusitis remains unclear, and if they are, what is the difference between those who develop the disease and those who remain free of symptoms. Trials of antifungal treatments have had mixed results.[43]

Recent theories of sinusitis indicate that it often occurs as part of a spectrum of diseases that affect the respiratory tract (i.e., the "one airway" theory) and is often linked to asthma.[44][45]

Both smoking and

secondhand smoke are associated with chronic rhinosinusitis.[14]

Other diseases such as cystic fibrosis and granulomatosis with polyangiitis can also cause chronic sinusitis.[46]

Maxillary sinus

posterior tooth, where the inflammatory exudate has eroded through the bone superiorly to drain into the maxillary sinus.[36]

An estimated 0.5 to 2.0% of viral rhinosinusitis (VRS) will develop into bacterial infections in adults and 5 to 10% in children.[18]

Pathophysiology

mucosa of 75% of people undergoing surgery for chronic sinusitis.[51]

Diagnosis

Classification

Illustration depicting sinusitis, note the fluid in the sini

Sinusitis (or rhinosinusitis) is defined as an inflammation of the mucous membrane that lines the paranasal sinuses and is classified chronologically into several categories:[22]

Roughly 90% of adults have had sinusitis at some point in their lives.[52]

Acute

Health care providers distinguish bacterial and viral sinusitis by watchful waiting.[1] If a person has had sinusitis for fewer than 10 days without the symptoms becoming worse, then the infection is presumed to be viral.[1] When symptoms last more than 10 days or get worse in that time, then the infection is considered bacterial sinusitis.[53] Pain in the teeth and bad breath are also more indicative of bacterial disease.[54]

Imaging by either X-ray, CT or MRI is generally not recommended unless complications develop.[53] Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa. Classically, the increased pain when tilting the head forwards separates sinusitis from pulpitis.[citation needed]

For cases of maxillary sinusitis, limited field

radiographs, improves the ability to detect the teeth as the sources for sinusitis. A coronal CT picture may also be useful.[36]

Chronic

For sinusitis lasting more than 12 weeks, a

Hounsfield units (HU), but in a more chronic state they become more viscous, with a radiodensity of 30 to 60 HU.[55]

Nasal

fiber-optic
tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses.

Sinus infections, if they result in tooth pain, usually present with pain involving more than one of the upper teeth, whereas a toothache usually involves a single tooth. Dental examination and appropriate radiography aid in ruling out pain arises from a tooth.[32]

  • CT of chronic sinusitis
    CT of chronic sinusitis
  • CT scan of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone.
    CT scan of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone.
  • MRI image showing sinusitis. Edema and mucosal thickening appears in both maxillary sinuses.
    MRI image showing sinusitis. Edema and mucosal thickening appears in both maxillary sinuses.
  • Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis
    Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis
  • Frontal sinusitis
    Frontal sinusitis
  • X-ray of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side.
    X-ray of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side.

Treatment

Treatments for sinusitis[57][58]
Treatment Indication Rationale
Time Viral and some bacterial sinusitis Sinusitis is usually caused by a virus which is not affected by antibiotics.[57]
Antibiotics Bacterial sinusitis Cases accompanied by extreme pain, skin infection, or which last a long time may be caused by bacteria.[57]
Nasal irrigation Nasal congestion Can provide relief by helping decongest.[57]
Drink liquids Thick phlegm Remaining hydrated loosens mucus.[57]
Antihistamines
 Concern with
allergies
 Antihistamines do not relieve typical sinusitis or cold symptoms much; this treatment is not needed in most cases.[57]
Nasal spray Desire for temporary relief Tentative evidence that it helps symptoms.[6] Does not treat cause. Not recommended for more than three days' use.[57]

Recommended treatments for most cases of sinusitis include rest and drinking enough water to thin the mucus.[59] Antibiotics are not recommended for most cases.[59][60]

Breathing low-temperature steam such as from a hot shower or

upper respiratory infections.[6] Decongestant nasal sprays containing oxymetazoline may provide relief, but these medications should not be used for more than the recommended period. Longer use may cause rebound sinusitis.[62] It is unclear if nasal irrigation, antihistamines, or decongestants work in children with acute sinusitis.[63] There is no clear evidence that plant extracts such as Cyclamen europaeum are effective as an intranasal wash to treat acute sinusitis.[64] Evidence is inconclusive on whether anti-fungal treatments improve symptoms or quality of life.[65]

Antibiotics

Most sinusitis cases are caused by viruses and resolve without antibiotics.

antibiotic resistance, and cost.[67]

fluoroquinolones when other options are available due to higher risks of serious side effects.[70]

A short-course (3–7 days) of antibiotics seems to be just as effective as the typical longer-course (10–14 days) of antibiotics for those with clinically diagnosed acute bacterial sinusitis without any other severe disease or complicating factors.[71] The IDSA guideline suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The guidelines still recommend children receive antibiotic treatment for ten days to two weeks.[69]

Corticosteroids

For unconfirmed acute sinusitis, nasal sprays using corticosteroids have not been found to be better than a placebo either alone or in combination with antibiotics.[72] For cases confirmed by radiology or nasal endoscopy, treatment with intranasal corticosteroids alone or in combination with antibiotics is supported.[73] The benefit, however, is small.[74]

For confirmed chronic rhinosinusitis, there is limited evidence that intranasal steroids improve symptoms and insufficient evidence that one type of steroid is more effective.[75][76]

There is only limited evidence to support short treatment with corticosteroids by mouth for chronic rhinosinusitis with nasal polyps.[77][78][79] There is limited evidence to support corticosteroids by mouth in combination with antibiotics for acute sinusitis; it has only short-term effect improving the symptoms.[80][81]

Surgery

For sinusitis of dental origin, treatment focuses on removing the infection and preventing reinfection, by removal of the microorganisms, their byproducts, and pulpal debris from the infected root canal.[36] Systemic antibiotics are ineffective as a definitive solution, but may afford temporary relief of symptoms by improving sinus clearing, and may be appropriate for rapidly spreading infections, but debridement and disinfection of the root canal system at the same time is necessary. Treatment options include non-surgical root canal treatment, periradicular surgery, tooth replantation, or extraction of the infected tooth.[36]

For chronic or recurring sinusitis, referral to an

otolaryngologist may be indicated, and treatment options may include nasal surgery. Surgery should only be considered for those people who do not benefit with medication or have non-invasive fungal sinusitis[82][unreliable medical source?].[78][83] It is unclear how benefits of surgery compare to medical treatments in those with nasal polyps as this has been poorly studied.[84][85]

A number of surgical approaches can be used to access the sinuses and these have generally shifted from external/extranasal approaches to intranasal

propel mometasone furoate implant may help in recovery after surgery.[88]

Another recently developed treatment is

balloon angioplasty used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner.[40] The effectiveness of the functional endoscopic balloon dilation approach compared to conventional FESS is not known.[40]

Treatments directed to rhinovirus infection

A study has shown that patients given spray formulation of 0.73 mg of Tremacamra (a soluble intercellular adhesion molecule 1 [ICAM-1] receptor) reduced the severity of illness.[37]

Prognosis

A 2018 review has found that without the use of antibiotics, about 46% were cured after one week and 64% after two weeks.[66]

Epidemiology

Sinusitis is a common condition, with between 24 and 31 million cases occurring in the United States annually.[89][90] Chronic sinusitis affects approximately 12.5% of people.[14]

Research

Based on recent theories on the role that

fungi may play in the development of chronic sinusitis, antifungal treatments have been used, on a trial basis. These trials have had mixed results.[24]

See also

References

  1. ^
    S2CID 206469424
    .
  2. ^ a b c d e "Sinus Infection (Sinusitis)". cdc.gov. September 30, 2013. Archived from the original on 7 April 2015. Retrieved 6 April 2015.
  3. ^ Koralla DR (2021-06-27). "Sinus infection symptoms | Problems with sinuses". MedyBlog. Archived from the original on 2022-12-12. Retrieved 2022-12-13.[unreliable medical source?]
  4. ^ a b c Meghanadh DK (2022-11-18). "Complications of Sinusitis". Medy Blog. Archived from the original on 2023-01-09. Retrieved 2023-01-09.[unreliable medical source?]
  5. ^ "Migraines vs. Sinus Headaches". American Migraine Foundation. Archived from the original on 2017-07-28. Retrieved 2017-10-23.
  6. ^
    PMID 25892369. Archived
    (PDF) from the original on 2021-08-29. Retrieved 2018-04-20.
  7. ^
    ISBN 9780323085939. Archived
    from the original on 2016-06-03.
  8. S2CID 205210696. Archived
    (PDF) from the original on 2018-07-22. Retrieved 2019-09-17.
  9. ^ a b Meghanadh DK (2022-11-14). "What causes sinusitis infection?". Medy Blog. Archived from the original on 2022-12-12. Retrieved 2022-12-13.[unreliable medical source?]
  10. ^ a b Meghanadh DK (2022-11-16). "Sinusitis Diagnosis - How to identify it?". Medy Blog. Archived from the original on 2022-12-12. Retrieved 2022-12-13.[unreliable medical source?]
  11. ^
    S2CID 227165628. Archived
    (PDF) from the original on 2023-03-07. Retrieved 2023-01-21.
  12. ^ "How Is Sinusitis Treated?". April 3, 2012. Archived from the original on 5 April 2015. Retrieved 6 April 2015.
  13. ^ Meghanadh DK (2022-12-05). "Treatment for Sinusitis- Acute, Chronic & Subacute stages". Medy Blog. Archived from the original on 2022-12-13. Retrieved 2022-12-13.[unreliable medical source?]
  14. ^
    PMID 21890184
    .
  15. ^ a b c "Sinusitus Complications". Patient Education. University of Maryland. Archived from the original on 2010-02-22.
  16. ^ "Sinusitis". herb2000.com. Archived from the original on 2011-05-25. Incidence of acute sinusitis almost always set in following the appearance of a cold for several days at a stretch in the person to the point that all the profuse nasal discharge turns a distinct yellow or a dark green color, or perhaps very thick, and foul-smelling in some cases.[unreliable medical source?]
  17. ^
    PMID 24861778
    .
  18. ^
    PMID 31613481. Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License Archived 2017-10-16 at the Wayback Machine
    .
  19. ^ "Chronic Sinusitis". Cleveland Clinic. Archived from the original on 2023-09-26. Retrieved 2023-09-11.
  20. S2CID 40427174
    .
  21. PMID 14979299
    .
  22. ^ a b c Radojicic C. "Sinusitis". Disease Management Project. Cleveland Clinic. Archived from the original on November 14, 2012. Retrieved November 26, 2012.
  23. ^
    ISBN 978-0-8138-2131-3
    .
  24. ^
    PMID 18206715
    .
  25. S2CID 32773653
    .
  26. S2CID 13223135
    .
  27. S2CID 42926700
    .
  28. S2CID 33112170
    .
  29. PMID 8127580
    .
  30. PMID 7742444
    .
  31. PMID 7692375
    .
  32. ^
    OCLC 903962852
    .
  33. PMID 33583151
    .
  34. S2CID 28835025. Archived
    from the original on 2024-02-25. Retrieved 2021-03-27.
  35. ISBN 978-0-323-04903-0
    .
  36. ^ a b c d e f "Maxillary Sinusitis of Endodontic Origin" (PDF). American Association of Endodontists. 2018. Archived (PDF) from the original on 26 March 2019. Retrieved 26 March 2019.
  37. ^
    S2CID 201117207
    .
  38. ^ Mucormycosis at eMedicine
  39. OCLC 862758150
    .
  40. ^
    PMID 21735433
    .
  41. PMID 19544383
    .
  42. ^ Boodman SG (1999-11-23). "Mayo Report on Sinusitis Draws Skeptics". The Washington Post. Archived from the original on 2019-03-06. Retrieved 2018-06-01.
  43. PMID 19532095
    .
  44. PMID 9042022
    .
  45. S2CID 7490538
    .
  46. S2CID 5606258
    .
  47. PMID 16326178
    .
  48. S2CID 46197466
    .
  49. S2CID 7259509
    .
  50. ISBN 978-0-8247-0635-7. Archived
    from the original on 2014-01-07.
  51. S2CID 25830188
    .
  52. S2CID 23638755
    .
  53. ^
    S2CID 16593182
    .
  54. PMID 30858261
    .
  55. ISBN 9780323080873
    .
  56. ^ Harrison's Manual of Medicine 16/e
  57. ^
    ABIM Foundation. Consumer Reports. Archived
    (PDF) from the original on June 11, 2012. Retrieved August 17, 2012.
  58. ABIM Foundation. American Academy of Allergy, Asthma, and Immunology. Archived
    (PDF) from the original on November 3, 2012. Retrieved August 14, 2012.
  59. ^
    ABIM Foundation, Consumer Reports, archived
    (PDF) from the original on January 24, 2013, retrieved August 14, 2012
  60. PMID 30198548
    .
  61. PMID 17636843
    .
  62. ^ Rhinitis medicamentosa at eMedicine
  63. PMID 25347280
    .
  64. PMID 29750825
    .
  65. PMID 30199594
    .
  66. ^
    PMID 30198548
    .
  67. PMID 22450938
    .
  68. PMID 18362380
    .
  69. ^
    PMID 22438350
    .
  70. ^ "Fluoroquinolone Antibacterial Drugs: Drug Safety Communication – FDA Advises Restricting Use for Certain Uncomplicated Infections". FDA. 12 May 2016. Archived from the original on 16 May 2016. Retrieved 16 May 2016.
  71. PMID 19154447
    .
  72. PMID 18056902
    .
  73. PMID 24293353
    .
  74. PMID 22585889
    .
  75. S2CID 205210710. Archived
    from the original on 2019-11-15. Retrieved 2019-11-15.
  76. S2CID 205210689
    .
  77. PMID 27113367
    .
  78. ^
    S2CID 35987497
    .
  79. PMID 18438594
    .
  80. PMID 24664368. Archived
    (PDF) from the original on 2019-11-15. Retrieved 2019-11-15.
  81. S2CID 205210682
    .
  82. ^ Meghanadh DK (2022-12-16). "Fungal sinusitis - causes, symptoms, and treatment". Medy Blog. Archived from the original on 2023-05-05. Retrieved 2023-05-05.[unreliable medical source?]
  83. ^ Tichenor WS (2007-04-22). "FAQ — Sinusitis". Archived from the original on 2007-11-01. Retrieved 2007-10-28.
  84. PMID 25437000
    .
  85. PMID 25410644
    .
  86. S2CID 34575985
    .
  87. ^ a b Meghanadh DK (2023-02-07). "Sinusitis Surgery: An Overview of the Different Technologies". Medy Blog. Archived from the original on 2023-05-05. Retrieved 2023-05-05.[unreliable medical source?]
  88. PMID 23525506
    .
  89. PMID 20350632
    .
  90. PMID 20176255
    .

External links
Retrieved from "https://en.wikipedia.org/w/index.php?title=Sinusitis&oldid=1222476084"