This document discusses various types of acute rhinosinusitis. It defines acute rhinosinusitis as lasting less than 4 weeks with complete resolution of symptoms. The most common types are described as acute viral rhinosinusitis, acute bacterial rhinosinusitis, acute maxillary sinusitis, acute frontal sinusitis, and acute ethmoid and sphenoid sinusitis. For each type, the causes, symptoms, diagnosis, and treatment options are outlined. Complications are also discussed if the infections are not properly treated.

1. SASI KUMAR
ACUTE RHINOSINUSITIS

2. DEFINITION
• EARLIER THE TERM SINUSITIS WAS USED WHICH MEANS INFLAMMATION
OF THE MUCOSA OF SINUSES
• HOWEVER, IT IS ASSOCIATED WITH INFLAMMATION OF THE NASAL
MUCOSA, HENCE THE TERM RHINOSINUSITIS

3. CLASSIFICATION
• RHINOSINUSITIS TASK FORCE (2007)
1. ACUTE RHINOSINUSITIS - LESS THAN 4 WEEKS WITH
COMPLETE RESOLUTION
2. SUBACUTE RHINOSINUSITIS - 4-12 WEEKS
3. CHRONIC RHINOSINUSITIS - ≥12 WEEKS
4. RECURRENT RHINOSINUSITIS - 4 OR MORE EPISODES PER
YEAR; EACH LASTING FOR 7-10 DAYS OR MORE WITH
COMPLETE RESOLUTION IN BETWEEN EPISODES

4. ACUTE VIRAL RHINOSINUSITIS
CAUSATIVE AGENTS
• RHINOVIRUSES
• INFLUENZA
• PARAINFLUENZA
• Spread by aerosolised droplets through coughing and sneezing
• Incubation period 1-4 days

5. Pathophysiology

6. CLINICAL FEATURES
• NASAL CONGESTION
• RHINORRHOEA
• SNEEZING
• LOW GRADE FEVER
• IMPROVES WITHIN A WEEK OR 10 DAYS

7. TREATMENT
• TROPICAL NASAL DECONGESTANTS AND ANTIHISTAMINES
• ANALGESICS
• ASPIRIN - CONTRAINDICATED
• NASAL SALINE SPRAYS

8. COMPLICATIONS
• UNCOMMON, AS IT IS SELF LIMITING
• IN CASE OF BACTERIAL INFECTION SUPERVENES OR IN
IMMUNOCOMPROMISED, IT CONVERTS INTO BACTERIAL RHINOSINUSITIS
CAUSING PHARYNGITIS, BRONCHITIS,PNEUMONIA OR OTITIS MEDIA

9. ACUTE BACTERIAL RHINOSINUSITIS
• FOLLOWS VIRAL RESPIRATORY INFECTION

10. CLINICAL FEATURES
• NASAL OBSTRUCTION
• PURULENT RHINORRHOEA
• FACIAL PAIN / PRESSURE
• HYPOSMIA / ANOSMIA
• COUGH, FEVER, HEADACHE, FULLNESS OF EAR, DENTAL PAIN,
HALITOSIS

11. DIAGNOSIS
• IF SYMPTOMS ACUTE VIRAL RHINOSINUSITIS PERSISTS OR WORSEN
BEYOND 10 DAYS
• NASAL ENDOSCOPY MAY REVEAL PURULENT DISCHARGE IN
OSTIOMEATAL COMPLEX
• SWAB FROM MIDDLE MEATUS FOR CULTURE AND SENSITIVITY OF
BACTERIA
• CT SCAN IS DONE IF ANY COMPLICATION IS SUSPECTED

12. TREATMENT
1. ANALGESICS : NSAIDs - TO RELIEVE HEADACHE AND SINUS
2. ANTIBIOTICS : AMOXICILLIN WITH / WITHOUT CLAVULANIC ACID
-FIRST LINE OF TREATMENT
-IF ALLERGIC TO PENICILLIN, DOXYCYCLINE,
LEVOFLOXACIN CAN BE GIVEN
3.SALINE IRRIGATION
4.ANTIHISTAMINES IN CASE OF ALLERGY
5.DECONGESTANTS
6.INTRANASAL STEROIDS

13. ACUTE MAXILLARY SINUSITIS
AETIOLOGY
• MOST COMMONLY , IT IS VIRAL RHINITIS WHICH SPREADS TO INVOLVE
THE SINUS MUCOSA
• FOLLOWED BY BACTERIAL INVASION
• SWIMMING IN CONTAMINATER WATER
• DENTAL INFECTIONS ARE IMPORTANT SOURCE OF MAXILLARY SINUSITIS
• TRAUMA TO THE SINUS

14. CLINICAL FEATURES
• CONSTITUTIONAL SYMPTOMS - FEVER, GENERAL MALAISE, BODYACHE
• HEADACHE
• PAIN - TYPICALLY, OVER THE UPPER JAW AND MAY REFER TO GUMS.
- AGGRAVATED BY STOOPING, COUGHING OR CHEWING
• TENDERNESS
• REDNESS AND OEDEMA OF CHEEK
• NASAL DISCHARGE
• POSTNASAL DISCHARGE

15. DIAGNOSIS
• TRANSILLUMINATION TEST - SINUS - OPAQUE
• X RAYS - WATERS’ VIEW - SHOWS EITHER OPACITY OR FLUID IN THE
INVOLVED SINUS
• COMPUTED TOMOGRAPHY

16. TREATMENT
• MEDICAL - ANTIMICROBIAL DRUG - AMPICILLIN AND AMOXICILLIN
- NASAL DECONGESTANT DROPS - 1% EPHEDRINE
- STEAM INHALATION - STEAM ALONE OR WITH MENTHOL
- ANALGESICS
- HOT FOMENTATION
• SURGICAL - ANTRAL LAVAGE

17. COMPLICATIONS
1. SUBACUTE OR CHRONIC SINUSITIS
2. FRONTAL SINUSITIS
3. OSTEITIS OR OSTEOMYELITIS
4. ORBITAL CELLULITIS OR ABSCESS

18. ACUTE FRONTAL SINUSITIS
AETIOLOGY
• VIRAL INFECTION FOLLOWED LATER BY BACTERIAL INVASION
• SWIMMING IN CONTAMINATED WATER
• TRAUMA TO SINUS
CLINICAL FEATURES
1. FRONTAL HEADACHE
2. TENDERNESS
3. OEDEMA OF UPPER EYELIDS
4. NASAL DISCHARGE

19. TREATMENT
MEDICAL - 1. ANTIMICROBIALS
2. HISTAMINIC + ORAL NASAL DECONGESANT
3. COTTON SOAKED IN A VASOCONSTRICTOR IN MIDDLE
MEATUS TWICE DAILY RELIEVE OSTIAL OEDEMA AND
PROMOTES SINUS DRAINAGE AND VENTILATION

20. SURGICAL
• TREPHINATION OF FRONTAL SINUS
FRONTAL SINUS IS DRAINED
- IF THERE IS PERSISTENT OF PAIN OR PYREXIA IN SPITE OF
MEDICAL TREATMENT FOR 48 HRS
- IF THE LID SWELLING IS INCREASING AND THREATENING
ORBITAL CELLULITIS

22. COMPLICATIONS
1. ORBITAL CELLULITIS
2. OSTEOMYELITIS OF FRONTAL BONE AND FISTULA FORMATION
3. MENINGITIS, EXTRADURAL ABSCESS, FRONTAL LOBE ABCESS
4. CHRONIC FRONTAL SINUSITIS

23. ACUTE ETHMOID SINUSITIS
AETIOLOGY
• ASSOCIATED WITH INFECTION OF OTHER SINUSES
• M/C IN INFANTS AND CHILDREN
CLINICAL FEATURES
1. PAIN - AGGRAVATED BY MOVEMENTS OF THE EYE BALL
2. OEDEMA OF LIDS
3. NASAL DISCHARGE
4. SWELLING OF THE MIDDLE TURBINATE

24. TREATMENT
• ANTIMICROBIAL
• NASAL DECONGESTANT DROPS
• ANALGESICS
• HOT FOMENTATION
COMPLICATIONS
• ORBITAL CELLULITIS AND ABSCESS
• VISUAL DETERIORATION AND BLINDNESS
• CAVERNOUS SINUS THROMBOSIS
• EXTRADURAL ABSCESS, MENINGITIS, BRAIN ABSCESS

25. ACUTE SPHENOID SINUSITIS
AETIOLOGY
• OFTEN A PART OF PANSINUSITIS OR ASSOCIATED WITH INFECTION OF POSTERIOR
ETHMOID SINUSES
CLINICAL FEATURES
1. HEADACHE - LOCALIZED TO OCCIOUT OR VERTEX
2. PAIN MAY ALSO BE REFERRED TO MASTOID REGION
3. POSTNASAL DISCHARGE - STREAK PUS SEEN ON THE ROOF AND POSTERIOR
WALL OF NASOPHARYNX OR ABOVE THE POSTERIOR END OF MIDDLE TURBINATE
TREATMENT
• SAME AS FOR ACUTE INFECTION OF OTHER SINUSES

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