Rhinosinusitis

  • Chris de Souza
  • Rosemarie A. de Souza

Abstract

■ Inflammation causes changes in the nasal and sinus mucosa.

■ Edema occurs and this is followed by a transudate. The effect of edema is that it causes obstruction of the ostia of the sinuses, thereby causing impairment in the drainage of secretions.

■ The quality of the mucus changes.

■ Inflammation causes the cilia to become paralyzed. This may be temporary or sustained, depending upon the severity of damage.

■ The outcome of all these changes is that mucus collects within the sinuses and stasis occurs.

■ Initially, the secretions are sterile. They can soon get contaminated with bacteria by nose-blowing, which forces the bacteria into the sinuses from the nasal cavity.

■ This results in an acute bacterial infection within the sinuses.

■ This can resolve either spontaneously or with the aid of medication. If it does not resolve it can result in chronic disease.

■ The criteria for the diagnosis of acute (presumed bacterial) rhinosinusitis include having symptoms that persist for 10 days up to a maximum of 24 days.

■ Fever should be present. Symptoms for diagnosis should include anterior and/or posterior nasal discharge, nasal obstruction, and facial pain.

■ Objective documentation should include a nasal airway examination for purulent discharge and radiographic evidence of acute rhinosinusitis.

■ Both nasal endoscopy and CT are objective measures that can increase the accuracy of the chronic rhinosinusitis (CRS) diagnosis.

■ Nasal endoscopic observation of pus, polyps or other disease can help confirm a diagnosis of CRS.

■ For areas that cannot be observed with nasal endoscopy, CT can be useful in helping to diagnose disease.

■ The use of combining symptoms, findings on nasal endoscopy, and the findings on CT scans can reliably and accurately diagnose and treat CRS.

■ Newer instruments and powered tools are now available making mucosal preservation possible.

■ Areas in the healing sinus cavity that demonstrate polypoid mucosa are most likely the areas that will demonstrate persistent inflammation. This is likely due to an osteitis reaction.

■ Aggressive postoperative debridement of devitalized bone in these areas will result in improved epithelialization of the sinus cavity. Simultaneously, equally aggressive management of infection and inflammation is needed.

■ Long-term antibiotics and long-term application of topical steroids are appropriate for the management of these conditions.

■ Literature is accumulating in support of the use of topical steroids, which are given preoperatively as well as postoperatively.

■ Details of endoscopic sinus surgery are provided elsewhere in this textbook.

■ It has been found that a definite relationship exists among allergy, bronchial asthma, and RS.

■ The allergic component must be treated appropriately if the management of RS is to be successful.

■ Similarly, successful sinus surgery results in a better ability to control bronchial asthma.

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References

  1. 1.
    Al Ghamdi K, Ghaffar O, Small P et al. (1997): IL-4 and IL-13 expression in chronic sinusitis: relationship with cellular infiltrate and effect of topical corticosteroid treatment. Journal of Otolaryngology 26:160–166PubMedGoogle Scholar
  2. 2.
    Asraf N, Bhattacharya N (2001): Determination of the “incidental”. Lund score for the staging of chronic sinusitis Otolaryngology Head & Neck Surgery 125(5):483–486Google Scholar
  3. 3.
    Baroody FM, Suh, SH, Naclerio RM (1997): Total IgE serum levels correlate with sinus mucosal thickness on computerized tomography scans. Journal of Allergy and clinical Immunology 100:563–568PubMedCrossRefGoogle Scholar
  4. 4.
    Bhattacharya N (2005): Symptom and disease severity differences between nasal septal deviation and chronic rhinosinusitis. Otolaryngology Head & Neck Surgery 133:173–177CrossRefGoogle Scholar
  5. 5.
    Bhattacharya N, Piccirilo Wippold FJ (1997): Relationship between patient based descriptions of sinusitis and paranasal sinus computed tomographic findings. Archives of Otolaryngology – Head and Neck Surgery 123;1189–1192Google Scholar
  6. 6.
    Blackwell DL, Collins JG, Coates (2002): Summary health statistics for US adults. National Health Interview. Vital Health Statistics 10:205Google Scholar
  7. 7.
    Bolger WE, Leonard D, Dick EJ et al. (1997): Gram negative sinusitis: a bacteriologic and histologic study in rabbits. American Journal of Rhinology 11:15–25PubMedCrossRefGoogle Scholar
  8. 8.
    Brook I (2005): The role of bacteria in chronic rhinosinusitis. Otolaryngologic Clinics of North America 38:1171–1192PubMedCrossRefGoogle Scholar
  9. 9.
    Cassiano R (1997): Correlation of clinical examination with computerized tomography in paranasal sinus disease. American Journal of Rhinology 11:193–196CrossRefGoogle Scholar
  10. 10.
    Catalano PJ, Setliff RC, Catalano LA (2001): Minimally invasive sinus surgery in the geriatric patient. Operative techniques. Otolaryngology Head & Neck Surgery 12(2):85–90Google Scholar
  11. 11.
    Cervin A, Wallwork B (2005): Anti-inflammatory effects of macrolides antibiotics in the treatment of chronic rhinosinusitis. Otolaryngologic Clinics of North America 38;1339–1350PubMedCrossRefGoogle Scholar
  12. 12.
    Chiu AG (2005): Osteitis in chronic rhinosinusitis. Otolaryngologic Clinics of North America 38:1237–1242 PubMedCrossRefGoogle Scholar
  13. 13.
    Driscoll PV, Naclerio RM, Baroody FM (1996): CD4+ lymphocytes are increased in the sinus mucosa of children with chronic sinusitis. Otolaryngology Head & Neck Surgery 122;1071–1076Google Scholar
  14. 14.
    Dykewicz MS, Fineman S (1998): Diagnosis and management of rhinitis: parameter documents of the joint task force on practice parameters in allergy, asthma and immunology. Annals of Allergy 81;463–518Google Scholar
  15. 15.
    English GM (1986): Nasal polypectomy and sinus surgery in patients with asthma and aspirin idiosyncracy. Laryngoscope 96:374–380PubMedCrossRefGoogle Scholar
  16. 16.
    Flinn J, Chapman ME, Wightman AJ, Maran AG (1994): A prospective analysis of incidental paranasal sinus abnormalities on CT head scans. Clinical Otolaryngology 19(4) 287–289.PubMedCrossRefGoogle Scholar
  17. 17.
    Friedman R, Ackerman M, Wald E (1984): Asthma and bacterial sinusitis in children. Journal of Allergy and Clinical Immunology 74:185–189PubMedCrossRefGoogle Scholar
  18. 18.
    Fuller CG, Schoettler JJ, Gilsanz V et al. (1994): Sinusitis in status asthmaticus. Clinical Pediatrics 33:712–719PubMedCrossRefGoogle Scholar
  19. 19.
    Glicklich RE, Metson RA (1994): A comparison of sinus computed tomography (CT) staging systems for outcomes research. American Journal of Rhinology 8;291–297CrossRefGoogle Scholar
  20. 20.
    Glicklich R, Metson R (1997): Effect of sinus surgery on quality of life. Otolaryngology Head & Neck Surgery 117;12–17CrossRefGoogle Scholar
  21. 21.
    Gwaltney JM, Wiesinger BA, Patrie JT (2004): Acute community acquired bacterial sinusitis; the value of antimicrobial treatment and the natural history. Clinical Infectious Diseases 38;227–233PubMedCrossRefGoogle Scholar
  22. 22.
    Harlin SI, Ansel DG, Lane SR et al. (1988): A clinical and pathological study of chronic sinusitis: the role of the eosinophil. Journal of Allergy and Clinical Immunology 81;867–875PubMedCrossRefGoogle Scholar
  23. 23.
    Hoover GE, Newman LJ, Platts-Mills TAE et al. (1997): Chronic sinusitis: risk factors for extensive disease. Journal of Allergy and Clinical Immunology 100;185–191PubMedCrossRefGoogle Scholar
  24. 24.
    Hughes R, Jones NS (1998): The role of endoscopy in outpatient management. Clinical Otolaryngology 23;224–226PubMedCrossRefGoogle Scholar
  25. 25.
    Jones NS (2002): CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clinical Otolaryngology 27;11–17PubMedCrossRefGoogle Scholar
  26. 26.
    Kennedy DW (1992): Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 102;1–18PubMedGoogle Scholar
  27. 27.
    Kennedy DW (1995): Conference on sinus disease: Terminology, staging, therapy. Annals of Otology, Rhinology and Laryngology 10410 (supplement pt 2);167Google Scholar
  28. 28.
    Kennedy DW, Senior BA, Gannon FH et al. (1998): Histology and histomorphometry of ethmoid bone in chronic sinusitis. Laryngoscope 108;502–507PubMedCrossRefGoogle Scholar
  29. 29.
    Lanza DC, Kennedy DW (1997): Adult rhinosinusitis defined. Otolaryngology Head & Neck Surgery 117;(3) S1–7CrossRefGoogle Scholar
  30. 30.
    Lund VJ (2005): Maximal medical therapy for chronic rhinosinusitis. Otolaryngologic Clinics of North America 38;1301–1310.PubMedCrossRefGoogle Scholar
  31. 31.
    Lund VJ, McKay IS (1993): Staging in rhinosinusitis. Rhinology 31;183–184PubMedGoogle Scholar
  32. 32.
    Marney SR (1996): Pathophysiology of reactive airway disease and sinusitis. Annals of Otology, Rhinology and Laryngology 105;98–100Google Scholar
  33. 33.
    Meltzer EO Hamilos DL et al. (2004): Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngology Head & Neck Surgery (supplement): 131;(6) 1–62CrossRefGoogle Scholar
  34. 34.
    Metson R, Glicklich RE, Stankiewicz JA et al. (1997): comparison of sinus computed tomography staging systems. Otorhinolaryngology – Head and Neck Surgery 117;372–379CrossRefGoogle Scholar
  35. 35.
    Newman LJ, Platts Mills TAE, Phillips CD et al. (1994): Chronic sinusitis relationship of computed tomographic findings to allergy, asthma and eosinophilia. JAMA 271;363–367PubMedCrossRefGoogle Scholar
  36. 36.
    Norlander T, Westrin KM, Stierna P (1994): The inflammatory response of the sinus and nasal mucosa during sinusitis: Implications for research and therapy. Acta Otolaryngologica Supplement 515;38–44CrossRefGoogle Scholar
  37. 37.
    Oliveira C, Sole D (1997): Improvement of bronchial hyperresponsiveness in asthmatic children treated for concurrent sinusitis. Annals of Allergy, Asthma and Immunology 79:70–74Google Scholar
  38. 38.
    Parsons DS, Phillips SE (1993): Functional endoscopic sinus surgery in children: a retrospective analysis of results. Laryngoscope 103;899–903PubMedGoogle Scholar
  39. 39.
    Perloff JR, Gannon FH, Bolger WE et al. (2000): Bone involvement in sinusitis; an apparent pathway for the spread of disease. Laryngoscope 110;2095–2099PubMedCrossRefGoogle Scholar
  40. 40.
    Rachelefsky GS, Katz RM, Siegel SC (1984): Chronic sinus disease with associated reactive airway disease in children. Pediatrics 73;526–532PubMedGoogle Scholar
  41. 41.
    Rolla G, Cologrande P, Scappaticci E, et al. (1997): Damage of the pharyngeal mucosa and hyperresponsiveness of airway in sinusitis. Journal of Allergy and Clinical Immunology 100;52–57PubMedCrossRefGoogle Scholar
  42. 42.
    Rossi OVJ, Pirila T, Laitinen J, et al. (1994): Sinus aspirates and radiographic abnormalities in severe attacks of asthma. International Archives of Allergy and Immunology 103;209–216PubMedCrossRefGoogle Scholar
  43. 43.
    Savolainen S (1989): Allergy in patients with acute maxillary sinusitis. Allergy 44;116–122PubMedCrossRefGoogle Scholar
  44. 44.
    Schlenter WW, Mann WJ (1983): Operative Therapie der chronischen Sinusitis – Erfolge bei allergischen und nichtallergischen Patienten. Laryngologie, Rhinologie, Otologie 62;284–288PubMedCrossRefGoogle Scholar
  45. 45.
    Schubert MS (2001): A superantigen hypothesis for the pathogenesis of chronic hypertrophic rhinosinusitis, allergic fungal sinusitis and related disorders. Annals of Allergy, Asthma and Immunology 87;181–188CrossRefGoogle Scholar
  46. 46.
    Seiberling KA, Grammer L, Kern RC (2005): Chronic rhinosinusitis and superantigens Otolaryngologic Clinics of North America 38;1215–1236PubMedCrossRefGoogle Scholar
  47. 47.
    Slavin RG (1998): Complications of allergic rhinitis: implications for sinusitis and asthma. Journal of Allergy and Clinical Immunology 101;S357–S360PubMedCrossRefGoogle Scholar
  48. 48.
    Stankiewicz J, Chow J (2002): Nasal endoscopy and the definition and diagnosis of chronic rhinosinusitis. Otolaryngology Head & Neck Surgery 126 (6);623–627CrossRefGoogle Scholar
  49. 49.
    TenBrinke A, Grootendorst D, Schmidt et al. (2002): Chronic sinusitis in severe asthma is related to sputum eosinophilia. Journal of Allergy and Clinical Immunology 109;621–626CrossRefGoogle Scholar
  50. 50.
    Yasan H, Dogru H, Baykal B et al. (2005): What is the relationship between chronic sinus disease and isolated nasal septum deviation. Otolaryngology Head & Neck Surgery 133;190–193CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Chris de Souza
    • 1
    • 2
    • 3
  • Rosemarie A. de Souza
    • 4
  1. 1.State University of New YorkBrooklynUSA
  2. 2.Health Sciences CenterLouisiana State UniversityShreveportUSA
  3. 3.The Tata Memorial Hospital, Lilavati Hospital, Holy Family HospitalMumbaiIndia
  4. 4.Department of Internal MedicineSion Hospital and LTMG Medical CollegeMumbaiIndia

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