27. Acute and chronic inflammations of the paranasal sinuses. Management principles.

what is rhinosinusitis

• Inflammation of the mucosal of the sinuses and nasal passages

what is the classification of rhinosinusitis

• Acute: < 4 weeks

• Subacute: 4 – 8 weeks

• Chronic: > 8 weeks

how does acute rhinosinusitis differ in children and adults

• in children affects ethmoid cells due to incomplete pneumatization of other sinuses

• In adults- maxilla > ethmoidal > frontal > Sphenoid sinus

what are the clinical signs of rhinosinusitis

• Primary: facial pain, nasal blockage, purulent discharge, loss of smell

• Secondary: headache fever, fatigue, dental pain, coughing

• Chronic rhinosinusitis: combination of primary and secondary signs

how do you diagnose rhinosinusitis

• History

  • 2 or more primary OR 1 primary and 2 secondary signs

• CT/ MR -> suspected complicated

• Nasal endoscopy- purulent discharge, mucosal swelling

what is the treatment of acute rhinosinusitis

• Mild- moderate

  • Intranasal CS

• Severe

  • INCS + antibiotics

• Adjuvant therapy

  • Saline irrigation, oral analgesics, oral/ topical decongestant

• Antibiotics

  • 1st line amoxicillin, 2nd line fluoroquinolones or amoxicillin clavulanic acid inhibitors

what is the treatment of chronic rhinosinusitis if polyps are present

INCS, oral steroids +/- antibiotics -> refer to ENT surgeons

what is the treatment of chronic rhinosinusitis if polyps are absent

INCS< oral steroids, antibiotics, saline irrigation

what is the treatment of chronic rhinosinusitis if surgery fails or its fungal sinusitis

• Balloon sinuplasty

• Functional endoscopic sinus surgery -> opening of entire ostiomeatal complex in order to facilitate drainage while sparing sinus mucosa