Sinusitis

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Annotated Information

Classification and Resources

ID 34
ICD-10
ICD-9-CM ICD9CM:461;ICD9CM:461.9;
OMIM
SNOMED-CT SNOMEDCT_2010_1_31:155498004;SNOMEDCT_2010_1_31:155501004;SNOMEDCT_2010_1_31:15805002;SNOMEDCT_2010_1_31:195649005;SNOMEDCT_2010_1_31:195653007;SNOMEDCT_2010_1_31:266378004;
Orphanet
MeSH
DO

Defination

Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the sinuses resulting in symptoms Common signs and symptoms include thick nasal mucous, a plugged nose, and pain in the face Other signs and symptoms may include fever, headaches, poor sense of smell, sore throat, and cough The cough is often worse at night Serious complications are rare It is defined as acute rhinosinusitis (ARS) if it lasts less than weeks, and as chronic rhinosinusitis (CRS) if it lasts for more than weeks~It can be due to infection, allergies, air pollution, or structural problems in the nose Most cases are due to a viral infection A bacterial infection may be present if symptoms last more than ten days or if a person worsens after starting to improve Recurrent episodes are more likely in people with asthma, cystic fibrosis, and poor immune function X-rays are not typically needed unless complications are suspected In chronic cases confirmatory testing is recommended by either direct visualization or computed tomography~Some cases may be prevented by hand washing, avoiding smoking, and immunization Pain killers such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms Treating ARS with or without an antibiotic is reasonable for uncomplicated bacterial cases If after a further seven days there is still no improvement antibiotics may either be recommended or changed In those in whom antibiotics are used, either amoxicillin or amoxicillin/clavulanate is recommended first line Surgery may occasionally be used in people with chronic disease~Sinusitis is a common condition It affects about between % and % of people each year in the United States and Europe Women are more often affected than men Chronic sinusitis affects approximately % of people Treatment of sinusitis in the United States results in more than billion USD in costs~

Synonyms

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Etiology

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Diagnosis

Acute[edit]~Bacterial and viral sinusitis are difficult to distinguish However, if symptoms last less than days, it is generally considered viral sinusitis When symptoms last more than days, it is considered bacterial sinusitis Imaging by either X-ray, CT or MRI is generally not recommended unless complications develop Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa Classically, the increased pain when tilting the head forwards separates sinusitis from pulpitis~Chronic[edit]~For sinusitis lasting more than weeks a CT scan is recommended Nasal endoscopy and clinical symptoms are also used to make a positive diagnosis A tissue sample for histology and cultures can also be collected and tested Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps In rare cases, sinusoscopy may be made~Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses This is generally a completely painless (although uncomfortable) procedure which takes between five to ten minutes to complete~~MRI image showing sinusitis Edema and mucosal thickening appears in both maxillary sinusesAdmin (talk)A computed tomograph showing infection of the ethmoid sinusAdmin (talk)Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis~~

Symptoms

Acute[edit]~Bacterial and viral sinusitis are difficult to distinguish However, if symptoms last less than days, it is generally considered viral sinusitis When symptoms last more than days, it is considered bacterial sinusitis Imaging by either X-ray, CT or MRI is generally not recommended unless complications develop Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa Classically, the increased pain when tilting the head forwards separates sinusitis from pulpitis~Chronic[edit]~For sinusitis lasting more than weeks a CT scan is recommended Nasal endoscopy and clinical symptoms are also used to make a positive diagnosis A tissue sample for histology and cultures can also be collected and tested Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps In rare cases, sinusoscopy may be made~Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses This is generally a completely painless (although uncomfortable) procedure which takes between five to ten minutes to complete~~MRI image showing sinusitis Edema and mucosal thickening appears in both maxillary sinusesAdmin (talk)A computed tomograph showing infection of the ethmoid sinusAdmin (talk)Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis~~

Treatment

Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis This pain is typically localized to the involved sinus and may worsen when the affected person bends over or when lying down Pain often starts on one side of the head and progresses to both sides Acute and chronic sinusitis may be accompanied by thick nasal discharge that is usually green in color and may contain pus (purulent) and/or blood Often a localized headache or toothache is present, and it is these symptoms that distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches Another way to distinguish between toothache and sinusitis is that the pain in sinusitis usually is worsened by tilting the head forwards and with valsalva maneuvers~Infection of the eye socket is possible, which may result in the loss of sight and is accompanied by fever and severe illness Another possible complication is the infection of the bones (osteomyelitis) of the forehead and other facial bones – Pott's puffy tumor~Sinus infections can also cause middle ear problems due to the congestion of the nasal passages This can be demonstrated by dizziness, "a pressurized or heavy head", or vibrating sensations in the head Post-nasal drip is also a symptom of chronic rhinosinusitis~Halitosis (bad breath) is often stated to be a symptom of chronic rhinosinusitis; however, gold standard breath analysis techniques have not been applied Theoretically, there are several possible mechanisms of both objective and subjective halitosis that may be involved~A study suggested that up to % of "sinus headaches" are actually migraines[verification needed] The confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain As a result, it is difficult to accurately determine the site from which the pain originates People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection~By location[edit]~There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses The ethmoidal sinuses is further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle turbinate In addition to the severity of disease, discussed below, sinusitis can be classified by the sinus cavity which it affects:~Maxillary – can cause pain or pressure in the maxillary (cheek) area (eg, toothache, or headache) (J/J)~Frontal – can cause pain or pressure in the frontal sinus cavity (located above eyes), headache, particularly in the forehead (J/J)~Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches (J/J)~Sphenoidal – can cause pain or pressure behind the eyes, but often refers to the skull vertex (top of the head), over the mastoid processes, or the back of the head~Complications[edit]~Stage~Description~I~Preseptal cellulitis~II~Orbital cellulitis~III~Subperiosteal abscess~IV~Orbital abscess~V~Cavernous sinus septic thrombosis~The close proximity of the brain to the sinuses makes the most dangerous complication of sinusitis, particularly involving the frontal and sphenoid sinuses, infection of the brain by the invasion of anaerobic bacteria through the bones or blood vessels Abscesses, meningitis and other life-threatening conditions may result In extreme cases the patient may experience mild personality changes, headache, altered consciousness, visual problems, seizures, coma and possibly death~Sinus infection can spread through anastomosing veins or by direct extension to close structures Orbital complications were categorized by Chandler et al into five stages according to their severity (see table) Contiguous spread to the orbit may result in periorbital cellulitis, subperiosteal abscess, orbital cellulitis, and abscess Orbital cellulitis can complicate acute ethmoiditis if anterior and posterior ethmoidal veins thrombophlebitis enables the spread of the infection to the lateral or orbital side of the ethmoid labyrinth Sinusitis may extend to the central nervous system, where it may cause cavernous sinus thrombosis, retrograde meningitis, and epidural, subdural, and brain abscesses Orbital symptoms frequently precede intracranial spread of the infection Other complications include sinobronchitis, maxillary osteomyelitis, and frontal bone osteomyelitis Osteomyelitis of the frontal bone often originates from a spreading thrombo-phlebitis A periostitis of the frontal sinus causes an osteitis and a periostitis of the outer membrane, which produces a tender, puffy swelling of the forehead~The diagnosis of these complication can be assisted by noting local tenderness and dull pain, and can be confirmed by CT and nuclear isotope scanning The most common microbial causes are anaerobic bacteria and S aureus Treatment includes performing surgical drainage and administration of antimicrobial therapy Surgical debridement is rarely required after an extended course of parenteral antimicrobial therapy Antibiotics should be administered for at least weeks Continuous monitoring of patients for possible intracranial complication is advised~

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References

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