Sinusitis
Inflammation of the paranasal sinuses may be acute, subacute, chronic, allergic, or hyperplastic.
Acute sinusitis usually results from the common cold and lingers in subacute form in only about 10% of patients. Chronic sinusitis follows persistent bacterial infection; allergic sinusitis accompanies allergic rhinitis; hyperplastic sinusitis is a combination of purulent acute sinusitis and allergic sinusitis or rhinitis. The prognosis is good for all types.
Causes
Sinusitis usually results from viral or bacterial infection. The bacteria responsible for acute sinusitis are usually pneumococci, other streptococci, Haemophilus influenzae, and Moraxella catarrhalis. Staphylococci and gram-negative bacteria are more likely to occur in chronic cases or in patients in intensive care.
Clinical TipOn rare occasions, fungi can also be an etiologic factor. Aspergillus fumigatus is the fungus most frequently associated with sinus disease.
Predisposing factors include any condition that interferes with drainage and ventilation of the sinuses, such as chronic nasal edema, deviated septum, viscous mucus, nasal polyps, allergic rhinitis, nasal intubation, nasogastric tubes, or debilitation related to chemo-therapy, malnutrition, diabetes, blood dyscrasias, chronic use of steroids, or immunodeficiency.
Bacterial invasion commonly occurs from the conditions listed above or after a viral infection. It may also result from swimming in contaminated water.
Signs and symptoms
Features vary with sinusitis type.
Acute sinusitis
The primary symptom of acute sinusitis is nasal congestion, followed by a gradual buildup of pressure in the affected sinus. For 24 to 48 hours after onset, nasal discharge may be present and later may become purulent. Associated symptoms include malaise, sore throat, headache, low-grade fever (temperature of 99° to 99.5° F [37.2° to 37.5° C]), malodorous breath, painless morning periorbital swelling, and a sense of facial fullness.
Characteristic pain depends on the affected sinus: maxillary sinusitis causes pain over the cheeks and upper teeth; ethmoid sinusitis, pain over the eyes; frontal sinusitis, pain over the eyebrows; and sphenoid sinusitis (rare), pain behind the eyes.
Subacute sinusitis
Purulent nasal drainage that continues for longer than 3 weeks after an acute infection subsides suggests subacute sinusitis. Other clinical features of the subacute form include a stuffy nose, vague facial discomfort, fatigue, and a nonproductive cough.
Other types
The effects of chronic sinusitis are similar to those of acute sinusitis, but the chronic form causes continuous mucopurulent discharge.
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