Rhinosinusitis

Overview

• Definition: Inflammation or infection of the nasal passages and sinuses.

Classification

• Acute Rhinosinusitis: Symptoms for less than 4 weeks.
• Subacute Rhinosinusitis: Symptoms between 4-12 weeks.
• Chronic Rhinosinusitis: Symptoms lasting more than 12 weeks.
• Recurrent Acute Rhinosinusitis: 4 or more episodes per year without symptoms between episodes.

Aetiology/ Risk Factors

• Upper respiratory tract infections.
• Allergies.
• Nasal polyps or tumours.
• Deviated nasal septum.
• Environmental factors: Smoke, pollution.

Clinical Features

• Nasal congestion and discharge.
• Facial pain or pressure.
• Reduced sense of smell (anosmia).
• Fever (more common in acute).
• Halitosis.

Investigations

• Nasal Endoscopy: To visualise nasal passages and sinuses.
• CT scan: Detailed imaging of sinuses, especially in chronic or complicated cases.
• Cultures: If bacterial cause suspected.

Management

• Conservative: Saline nasal irrigation, steam inhalation.
• Medical:
  • Analgesia (e.g., paracetamol).
  • Topical nasal corticosteroids (e.g., fluticasone).
  • Antibiotics (e.g., amoxicillin) for suspected bacterial cases.
  • Antihistamines for allergic rhinosinusitis.
• Surgical: Functional endoscopic sinus surgery (FESS) for refractory or complicated cases.

Complications

• Abscess formation.
• Osteomyelitis of surrounding bones.
• Meningitis or brain abscess (rare).
• Orbital cellulitis.

Key Points

• Rhinosinusitis can be due to a variety of causes, both infectious and non-infectious.
• Management is often conservative, but antibiotics may be needed for bacterial cases.
• Chronic rhinosinusitis may require surgical intervention.