Chronic Sinusitis Michael J. Simmons, M.D. Jefferson City Medical Group Department Chair ENT and Sinus Surgery Division
R
hinosinusitis is one of the most commonly diagnosed conditions in the United States. Early in this century, it was estimated that of all antibiotics prescribed in the United States, 18% for adults and 9% for children were prescribed for the diagnosis of sinusitis.1 Rhinosinusitis in the broadest terms is defined as inflammation of the paranasal sinus cavities and/or the nasal cavity itself. This diagnosis is made with a history of two major factors or one major and two minor factors which include: 2 Major Factors 1. Facial pain and/or pressure 2. Nasal obstruction 3. Purulent/discolored nasal or postnasal drainage 4. Anosmia or hyposmia 5. Fever Minor Factors 1. Headache 2. Halitosis 3. Fatigue 4. Dental pain 5. Cough 6. Ear pain and/or pressure 8
MISSOURI FAMILY PHYSICIAN April - June 2021
On examination, physical findings include purulent drainage, mucosal or turbinate edema or polyps and may be supported by x-rays which show opacification or air/fluid levels in the air spaces of the paranasal sinuses. The vast majority of acute rhinosinusitis episodes are viral events and are expected to be self-limiting without antibiotic requirement. Even acute bacterial sinusitis begins in most cases as a viral upper respiratory infection or an acute exacerbation of inhalant allergic disease which at onset do not require antibiotic treatment. If signs or symptoms last beyond ten days, bacterial infection may be present and antibiotics are indicated if the clinical situation warrants. The general pathogenesis of acute and chronic rhinosinusitis includes inflammation that causes obstruction of the sinus ostium. This triggers a cascade of impaired mucociliary clearance, mucus stasis, and subsequent bacterial overgrowth. Chronic rhinosinusitis (CRS) is defined by both duration and clinical criteria. Chronic rhinosinusitis is defined as 12 weeks or longer of two major symptoms listed above. An alternative to CRS is recurrent acute rhinosinusitis in which four or greater episodes of bacterial sinusitis requiring antibiotic therapy occur within a year. The patient has symptom resolution between episodes. Chronic rhinosinusitis is further defined by the absence (CRSsNP) or presence of intranasal polyps (CRSwNP).
