Acute inflammatory diseases of

the nose and paranasl sinuses.

Classification , clinical
symptoms, diagnosis and
methods of treatment
 Rhinosinusitis
Group of disorders characterized by
inflammation of the mucosa of the nose
and paranasal sinuses
 Rhinosinusitis
 More accurate term than “sinusitis” since
almost always preceded by or concomitant
symptoms of rhinitis
 Acute – less to 4 weeks
 Subacute – 4 to 8weeks
 Chronic – > 8 weeks
Etiology
 Local Factors Predisposing to
Rhinosinusitis
 Allergic rhinitis
 Anatomic abnormalitiy:
Deviated septum
 Concha bullosa
 Enlarged adenoids
 Haller cells
 Foreign body
 Nasal polyps
 Trauma
 Tumor
 Barotrauma
 Diving, swimming
 Smoke
 Topical decongestant
abuse
 Anatomic Drainage Pathways in the
Sinuses
Sinus Area Drainage pathway

Frontal Nasofrontal duct

Anterior ethmoid / Ostiomeatal unit

Maxillary

Posterior ethmoid / Sphenoidethmoidal

sphenoid recess
 Clinical Signs of Acute
Rhinosinusitis:
 Headache/facial pain  Ear pain/pressure
or pressure
 Halitosis (Fetid
 Nasal obstruction
breath)
 Nasal discharge  Dental pain
 Increased posterior  Fatigue
pharyngeal secretions
 Cough
 Hyposmia or anosmia
 Ear examination may
 Fever (acute) reveal eustachian
tube dysfunction
Differentiating Sinusitis from Rhinitis
Rhinitis Sinusitis
Nasal congestion Nasal congestion
Rhinorrhea clear Purulent rhinorrhea
Itching, red eyes Postnasal drip
Seasonal symptoms Headache
Nasal crease Facial pain
Cough, fever
Anosmia
 Pain in Acute Rhinosinusitis
 Maxillary – can cause pain or pressure in
the maxillary area (e.g., toothache,
headache)
 Frontal – can cause pain or pressure in
the frontal sinus cavity (located above
eyes), headache
 Pain in Acute Rhinosinusitis
 Ethmoid – can cause pain or pressure pain
between/behind the eyes and headaches
 Sphenoid – can cause pain or pressure
behind the eyes, but often refers to
the vertex, or top of the head.
 Diagnosis of Acute Bacterial
Rhinosinusitis
 Acute clinical pattern
 Objective confirmation
 Rhinoscopy
 Endoscopy
R
 Radiographic Evidence of
Rhinosinusitis

 Air fluid level

 Sinus opacification
 Mucus membrane
thickening of 4 to 6
mm or more
 CT scan Not
recommended for
routine management
 Complications of Rhinosinusitis
nonmeningeal and meningeal(intracranial)

 Orbitalcellulitis (ethmoid)
 Osteomyelitis (frontal)
 Meningitis
 Subdural/epidural empyema (frontal)
 Brain abscess (frontal)
 Cavernous sinus thrombosis (sphenoid)
 Treatment
 Conservative
 Nasal irrigation ( Saline irrigation)
 Decongestant nasal sprays
 Mucolytics
 Antihistamines
 Antibiotics
 Surgery

 Functional endoscopic sinus surgery
(FESS).
Acute sinusitis before and after
treatment