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- Acute sinusitis is a symptomatic inflammation of ≥1 paranasal sinuses of <4 weeks’ duration resulting from impaired drainage and retained secretions. Because rhinitis and sinusitis usually coexist, “rhinosinusitis” is the preferred term.
- Disease is subacute when symptomatic for 4–12 weeks and chronic when symptomatic for >12 weeks.
- System(s) affected: Head/Eyes/Ears/Nose/Throat (HEENT); Pulmonary
- Affects 31 million individuals in the US each year, with an estimated annual cost of $5.8 billion
- Diagnosis of acute bacterial rhinosinusitis remains the 5th leading reason for prescribing antibiotics.
- 2% of viral rhinosinusitis episodes have a bacterial superinfection.
Incidence highest in early fall through early spring (related to incidence of viral upper respiratory infection [URI]). Adults have 2–3 viral URIs per year; 90% of these colds are accompanied by viral rhinosinusitis.
- Viral URI
- Allergic rhinitis
- Cigarette smoking
- Dental infections and procedures
- Anatomic variations:
- Tonsillar and adenoid hypertrophy
- Turbinate hypertrophy, nasal polyps
- Deviated septum
- Cleft palate
- Immunodeficiency (e.g., HIV)
- Cystic fibrosis
No known genetic pattern
Hand washing to prevent transmission of viral infection
- Important features:
- Inflammation and edema of the sinus mucosa
- Obstruction of the sinus ostia
- Impaired mucociliary clearance
- Secretions that are not cleared become hospitable to bacterial growth.
- Inflammatory response (neutrophil influx and release of cytokines) damages mucosal surfaces.
- Viral: Vast majority of cases (rhinovirus, influenza A and B; parainfluenza virus; respiratory syncytial; adeno-, corona-, and enteroviruses)
- Bacterial (complicates 0.2–2% of viral cases):
- More likely if symptoms worsen after 5–7 days or do not improve >10 days
- S. pneumoniae, H. influenzae, and M. catarrhalis are the most common bacterial pathogens.
- Often overdiagnosed, which leads to overuse of and increasing resistance to antibiotics
- Fungal: Seen in immunocompromised hosts (uncontrolled diabetes, neutropenia, use of corticosteroids) or as a nosocomial infection