Excerpt from Sinusitis

Synonyms, Key Words, and Related Terms: sinusitis, sinus inflammation, sinus infection, paranasal sinuses, inflammation of paranasal sinuses, infection of paranasal sinuses, nasopharyngeal flora, sinus disease, upper respiratory infections, URI, acute sinusitis, subacute sinusitis, chronic sinusitis, bacterial sinusitis, allergic rhinitis, severe allergic rhinitis, rhinoviral infection, maxillary sinusitis, Haemophilus influenzae, H influenzae, Streptococcus pneumoniae, S pneumoniae, Bacteroides, Peptostreptococcus, Fusobacterium, Moraxella catarrhalis, M catarrhalis, Staphylococcus aureus, S aureus, Candida, Aspergillus, Phycomycetes

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Background

Sinusitis is the inflammation/infection of 1 or more paranasal sinuses and occurs with obstruction of the normal drainage mechanism. It is traditionally subdivided into acute (symptoms lasting <3 wk), subacute (symptoms lasting 3 wk to 3 mo), and chronic (symptoms lasting > 3 mo).

Pathophysiology

The paranasal sinuses, a part of the upper respiratory tract, are in direct communication with the nasopharynx. The sinuses are normally sterile. Because of the proximity to nasopharyngeal flora, obstruction can cause bacterial infection.

Diseases that obstruct drainage can result in a reduced ability of the paranasal sinuses to function normally. The sinus ostia may become occluded, leading to mucosal congestion. The mucociliary transport system becomes impaired, leading to more stagnation of secretion and epithelial damage, followed by decreased oxygen tension and subsequent bacterial growth.

Frequency

United States

An estimated more than 30 million patients in the United States have sinus disease. Upper respiratory infections (URIs) are one of the most common presentations in the ED. A viral infection associated with the common cold is the most frequent etiology of acute sinusitis. Only a small percentage (as low as 2%) of viral sinusitis cases are complicated by bacterial sinusitis. The challenge is to differentiate a simple URI and allergic rhinitis from sinusitis. Medical treatment is expensive, with an estimated $5 billion spent annually; another $60 billion is spent on surgical treatment each year.

Mortality/Morbidity

Sinusitis is rarely life threatening, but the close proximity of the paranasal sinuses to the central nervous system, the multiple fascial plains of the neck, and the associated venous and lymphatic channels can lead to serious complications.

Age

An estimated 5-10% of URIs in children are related to sinusitis, while up to 10% of URIs in adults are related to sinusitis. Sinusitis is rare in children younger than 1 year because the sinuses are poorly developed before that age.

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