Acute sinusitis

Acute sinusitis is an acute inflammation of the mucous membrane of one or more paranasal sinuses.

ICD-10 code

• J01 Acute sinusitis.
• J01.0 Acute maxillary sinusitis (acute antritis).
• J01.1 Acute frontal sinusitis.
• J0.2 Acute ethmoid sinusitis.
• J01.3 Acute sphenoidal sinusitis.
• J01.4 Acute pansinusitis.
• J01.8 Other acute sinusitis (acute sinusitis involving more than one sinus, but not pansinusitis).
• J01.9 Acute sinusitis, unspecified.

Epidemiology of acute sinusitis

Inflammatory diseases of the paranasal sinuses are considered one of the most pressing problems of otolaryngology. Among patients undergoing treatment in otolaryngology hospitals, from 15 to 36% are people suffering from sinusitis.

Sinusitis accounts for an even greater percentage of outpatient upper respiratory tract diseases. According to the National Center for Disease Statistics, sinusitis became the most common chronic disease in the United States in 1994. Almost every eighth person in the United States has sinusitis; in 1998, 34.9 million people in the United States had sinusitis.

In Germany, over the past decade, between 7 and 10 million people have been diagnosed with acute and chronic sinusitis.

In this regard, the treatment of rhinosinusitis is now considered one of the most pressing problems of otolaryngology. Thus, in the USA in 1996, expenses related to the diagnosis and treatment of sinusitis amounted to 5.8 billion dollars.

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Causes of Acute Sinusitis

The development of inflammation of the mucous membrane of the paranasal sinuses is facilitated by conditions of both general and local nature. General conditions include states of individual reactivity, constitutional prerequisites, immune forces of the body, as well as various unfavorable factors of the external environment. Among local factors, inflammation in the sinuses is most often facilitated by those in which the drainage function of the outlet openings, ventilation of the sinuses and the work of the mucociliary transport system are disrupted.

Acute Sinusitis - Causes and Pathogenesis

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Symptoms of acute sinusitis

Acute sinusitis is not only a local lesion, but a disease of the entire body with a reaction of many systems and organs. Manifestations of a general reaction to inflammation of the paranasal sinuses, in particular, are a feverish state and typical changes in the blood (in acute and exacerbations of chronic sinusitis), as well as general malaise, weakness, headaches. Since these symptoms also accompany other focal infections, local manifestations of inflammation acquire primary importance in the diagnosis of sinusitis.

Acute Sinusitis - Symptoms

Classification of acute sinusitis

According to the localization of the process, the following are distinguished:

• acute maxillary sinusitis;
• acute ethmoiditis;
• acute frontal sinusitis;
• acute sphenoiditis.

If all paranasal sinuses are involved in the pathological process, a diagnosis of pansinusitis is made; if only one half of the sinuses is involved, a diagnosis of hemisinusitis is made.

According to the etiological factor, viral and bacterial sinusitis are distinguished, according to the pathophysiological factor - catarrhal and purulent sinusitis. Most often, viral sinusitis corresponds to the catarrhal form, bacterial - to the purulent one.

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Screening

Screening for acute sinusitis involves X-ray examination of the paranasal sinuses in patients with acute respiratory diseases. Ultrasound diagnostic methods can be used as an alternative to X-ray.

Diagnosis of acute sinusitis

Of great importance in detecting sinusitis is the sequential performance of anterior, middle and posterior rhinoscopy. Rhinoscopic signs of sinusitis include: discharge in the nasal passages, hyperemia, edema and hyperplasia of the mucous membrane.

Pathological discharge in the middle nasal passage (anterior rhinoscopy), as a rule, indicates a possible lesion of the frontal and maxillary sinuses, anterior and middle cells of the ethmoid labyrinth, in the superior nasal passage (posterior rhinoscopy) - a possible lesion of the posterior cells of the ethmoid labyrinth and sphenoid sinus. However, the absence of pathological discharge in the nasal cavity does not exclude a disease of the sinuses. In particular, there may be no discharge (periodically or constantly) if the patency of the junction of the affected sinuses with the nasal cavity is impaired or if the discharge is highly viscous.

The most common complaints with inflammation of the paranasal sinuses are: headaches, difficulty breathing through the nose, abnormal discharge from the nose and nasopharynx, and olfactory disorders.

Acute Sinusitis - Diagnosis

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Indications for hospitalization

• Severe clinical course of acute sinusitis, suspicion of complications.
• Acute sinusitis against the background of severe concomitant pathology or immunodeficiency.
• The impossibility of carrying out special invasive manipulations in an outpatient setting.
• Social indications.

Acute Sinusitis - Treatment

Treatment goals for acute sinusitis

• Evacuation of pathological discharge from the paranasal sinuses.
• Elimination of the source of infection and inflammation.
• Restoration of normal drainage and aeration of the paranasal sinuses.

Prevention of acute sinusitis

The overwhelming majority of acute rhinosinusitis are caused by sinus infection due to rhinitis. Therefore, the main preventive direction is timely and adequate therapy of acute respiratory diseases and acute rhinitis (unloading therapy, restoration of aeration of paranasal sinus drainage).

In case of odontogenic maxillary sinusitis, prevention consists of timely sanitation of the teeth of the upper jaw.

Anatomical defects of the nasal cavity (curvature of the nasal septum, hypertrophy of the nasal turbinates) can also lead to acute sinusitis; the question of surgical correction of these defects is raised only when chronic sinusitis develops.

Forecast

With adequate therapy of acute sinusitis, the prognosis is favorable. Complete elimination of the pathological process occurs within 7-10 days. With inadequate and untimely treatment, the process may transition to a chronic phase.

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