Rhinosinusitis


Rhinosinusitis

Description, Causes and Risk Factors:

Rhinosinusitis is one of the most common long-term illnesses in the United States and the rest of the world, affecting almost everyone. Rhinosinusitis is a challenging condition to treat, partly due to its multifaceted, poorly understood pathophysiology.

Rhinosinusitis involves the physiological disruption of the mucous membranes from particulates, allergens, infection, and immune system dysregulation. The term rhinosinusitis refers to inflammation of the contiguous tissues of the upper respiratory tract [URI], where insult to the nasal mucosa also affects adjacent sinus tissue.

Numerous causes for chronic rhinosinusitis have been proposed, which may include:

    Allergy: Some studies have shown that inhalant allergy seems to occur more commonly in patients with rhinosinusitis than in the general population; thus, it has been proposed that allergy may be factor in the development of rhinosinusitis.

  • Bacterial Infection: In at least some patients with rhinosinusitis, the presence of specific bacteria seems related to the status of the rhinosinusitis. In this view, bacteria start and sustain the process of chronic rhinosinusitis.

  • Biofilms: Biofilms are complex, three-dimensional structures of living bacteria. They have been identified in approximately 25-33% of patients with chronic rhinosinusitis in some studies.

  • Fungal Infection: Cultures of sinus secretions from patients with rhinosinusitis have grown fungus. Furthermore, it has been shown that the immune system of patients with rhinosinusitis have a greater response when exposed to fungal proteins at least in the laboratory.

  • Genetic Disorders: Patients with cystic fibrosis (CF), a hereditary condition that effects mostly the lungs, also develop significant rhinosinusitis. CF and other genetic diseases may be causes of chronic rhinosinusitis.

  • Mucociliary dysfunction: Under normal circumstances, the lining of the sinuses is covered by a think blanket of mucus, which is propelled in a programmed fashion by cilia on the surface of the sinus lining. These cilia act as oars to move the mucus. Disruption of this activity leads to stagnation of the mucus, and eventually infection and rhinosinusitis.

  • OMC Compromise: The ostiomeatal complex region is the common outflow channel for the anterior ethmoid, frontal and maxillary sinuses. Blockage of the OMC causes blockage of the `upstream' sinuses and lead to rhinosinusitis.

  • Staphylococcal Superantigen: Certain species of Staphylococcus can secrete substances (known as exotoxins) that can directly stimulate the immune system to produce a strong inflammatory reaction and rhinosinusitis.

  • Miscellaneous: ASA triad (aspirin-sensitive asthma triad).

  • Churg-Straus Syndrome (also known as granulomatous vasculitis) results from inflammation of blood vessels. Patients with this condition have severe asthma, sinusitis and other related illnesses.

Certain occupations, eg, woodworking and carpentry, paint, solvent and dye manufacturing, chemical plants, hazardous waste disposal units, oil and gas distilleries and leather tanning may expose workers to occupational toxins which exacerbate a pre-existing nasal condition and potentiate an inflammatory reaction in the sinuses and lead to rhinosinusitis.

In medical outcomes studies, health related quality of life measures have shown that chronic rhinosinusitis elicits similar responses to other severe chronic illnesses, including nasal polyps, congestive heart failure [CHF], angina pectoris and chronic obstructive pulmonary disease [COPD].

Symptoms:

The following symptoms are associated with rhinosinusitis:

    Nasal congestion.

  • Nasal discharge.

  • Postnasal drip.

  • Facial pressure or pain.

  • Fatigue and weakness.

  • Headache.

  • Decreased sense of smell.

  • Cough.

  • Fever.

  • Sore throat.

  • Asthma is found in 20-35% of patients with chronic rhinosinusitis. Rhinosinusitis is found in up to 75% of moderate-to severe asthmatics. A study of 200 consecutive cases of chronic rhinosinusitis found allergic rhinitis in 56% of patients.

Diagnosis:

Diagnosing rhinosinusitis will include the following:

Your doctor will ask for a complete medical history and will perform a thorough physical examination.Nasal endoscopy is performed on all patients in the clinic using a small lighted scope with a camera. This painless procedure allows our sinus doctors to examine the inside of the nose and sinuses.Sinus computed tomography (CT) scans are obtained for most patients. These provide a detailed image of the inside of the sinuses.

In some cases laboratory tests are obtained for patients with:

    Suspected allergies.

  • Cystic fibrosis.

  • Immune deficiencies.

  • Mucociliary disorders.

  • Other rare sinonasal diseases.

Screening for total IgG, IgA and IgM should be considered, particularly when rhinosinusitis is combined with otitis, bronchitis, or bronchiectasis. Evaluation of the patient's ability to mount an antibody response to bacteria can be tested by immunization with Streptococcus pneumoniae vaccine, Haemophilus influenzae type b (HIB) conjugated to protein, and/or tetanus toxoid, and measurement of antibody response following immunization. On rare occasions further tests of cellular immunity are indicated.

Treatment:

Treatment for rhinosinusitis varies, and is usually based on the duration and severity of symptoms. If possible, a culture should be taken of nasal drainage to identify the cause of the illness. If your doctor's evaluation suggests that the infection is bacterial, antibiotics will be prescribed. Antibiotics will not be given for infections caused by viruses, since antibiotics will have no effect whatsoever on these infections.

Symptoms can be often similar regardless of the cause, and can be managed using a few different techniques, such as over-the-counter pain relievers, nasal irrigation, or topical steroids. Allergic rhinosinusitis is often treated with antihistamines as well.

In the case of chronic rhinosinusitis, sometimes endoscopic sinus surgery is necessary. Endoscopic sinus surgery has been proven very successful in treating chronic rhinosinusitis.

For more specialized treatment options consult Multidisciplinary Approach.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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