Rhinosinusitis

1. RHINOSINUSITIS
ENT DEPARTMENT, CHUK
BY NIYOMUGABO Clisson, DOC II
10/02/2022

2. content
 Introduction
 Classification
 Risk factors
 Clinical presentation
 Investigation
 Management
 Complications

3. Rhinosinusitis
 Rhinosinusitis is the inflammation of the mucosal lining of the nasal cavity and
paranasal sinuses.
 we have four paranasal sinus:
 Frontal sinus
 Ethmoid sinus
 Sphenoid sinus
 Maxillary sinus
 These paranasal sinuses drain into the nasal cavity

4. Classification of acute rhinosinusitis
 AVRS (Common colds) are defined as acute viral
rhinosinusitis with a duration of symptoms of <10
days (but less than 12 weeks).
 APVRS (Acute post-viral rhinosinusitis) When
symptoms increase after five days, or when symptoms
are persistent for more than 10 days, with less than
12 weeks duration.

5. Cont’
 ABRS (Acute bacterial rhinosinusitis) is defined by at least three symptoms/signs of
Discolored mucus, Severe local pain (often unilateral), Fever > 38°C, Raised
CRP/ESR‘double’ sickening.
 RARS (recurrent acute rhinosinusitis) is defined as ≥4 episodes per year with
symptom free intervals. Each episode must meet the criteria for acute post-viral or
bacterial rhinosinusitis.

6. Pathophysiology
rhinosinusitis is triggered by three factors :
 obstruction of sinus drainage pathways (sinus ostium): foreign body, nasal
polyp, rhinitis, deviated septum…
 ciliary impairment: depend on mucociliary transport mechanism not gravity.
Can be caused by immobile cilia, bacterial or viral inoculation, contact
between 2 mucosal surfaces….
 altered mucus quantity and quality: mucus have 2 layers, inner serous layer
(sol phase) in which cilia recover from their active beat, and outer viscous
layer (gel phase) which is transported by ciliary beats. Ex: cystic fibrosis,
overproduction.

7.  The cascade of inflammation will lead to damage by the infiltrating cells, causing oedema,
engorgement, fluid extravasation, mucus production and sinus obstruction in the process.
 Stasis of secretions inside the sinus proliferation of various pathogens rhinosinusitis.

8. Risk factors
 The most organisms found are:
 Viruses: rhinovirus, corona virus, influenza A and B, RSV, Parainfluenza
 Bacteria: S. pneumonia, H. influenza, M. cattarrhalis.
 Active or passive smoking
 Anatomical variation, such as septal deviation
 Odontogenic infection
 Concomitant chronic diseases such as asthma, cystic fibrosis
 Immune system disorders such as HIV/AIDS

9. Clinical presentation
 Nasal blockage, congestion or stuffiness
 Nasal discharge or postnasal drip, often mucopurulent
 Facial pain or pressure
 Reduction/loss of smell
 Fever
 other symptoms: headache, cough, fatigue, ear (pain, pressure
or fullness), halitosis, dental pain.

10. Investigations
 Lab tests: CRP/ ESR, procalcitonin
 rhinoscopy
 Nasal swab
 Imaging studies: when there’s no response to medication after 2weeks
o X-ray of paranasal sinuses (PNS) to demonstrate fluid level, pus or opacity
o CT scan of paranasal sinuses without contrast is standard, it may show thickening of
mucosa.

11. Management
 Medication:
 Analgesia
 Nasal decongestants
 Antihistamines
 Nasal saline
 Nasal steroids
 Oral antibiotics
 Ballon sinuplasty for RARS.
 FESS

12. Red flag symptoms
 Eye signs: periorbital swelling, displaced globe,
double vision, ophtalmoplegia.
 Severe unilateral headache, frontal swelling, frontal
headache.
 Reduced level of consciousness.

13. Complications of ABRS
 Orbital complication (chandler’s classification)
 Stage 1: pre-septal cellulitis
 Stage 2: orbital cellulitis
 Stage 3: subperiosteal abscess
 Stage 4: orbital abscess
 Stage 5: cavernous sinus thrombosis
 Nasal septal abscess
 Osteomyelitis
 Pott’s puffy tumour (osteomyelitis of the frontal
sinus)

14. Take home message
acute rhinosinusitis is inflammation of the mucosal lining of the nasal passage
and paranasal sinuses.
Symptoms usually last for few days and can include nasal obstruction,
discharge, facial pain, hyposmia.
Most cases can be diagnosed clinically and managed conservatively (antibiotics
are not routinely required)
If no improvement on treatment (7-14 days) or presence of red-flag symptoms
refer to ENT specialist.

15. References
 EPOS 2020 article
 Current diagnosis and treatment-Otolaryngology 3rd ed-
A.Lalwani(McGraw-Hill Lange)
 Uptodate
 medscape

16. Thank you