chronic sinusitis
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Clinical manifestations
- sinusitis for >= 12 weeks
- see acute sinusitis
- despite symptoms suggesting chronic sinusitis, sinus inflammation & sinus infection are often absent on endoscopy.[1]
Laboratory
- nasal cytology
- modified Wright-Giemsa or Hansel stain
- > 5 neutrophils per high-power field
- 85% sensitivity, 40% specificity
- >5 eosinophils per high-power field
- sinus aspiration (endoscopy) & culture is the gold standard
- cultures of nasal secretions are useless
Diagnostic procedures
- rhinoscopy
- used by otolaryngologists & allergists
- check for nasal polyps[2]
- endoscopy
- sinus aspiration & culture
- useful for draining sinus
- useful for ruling out vs making diagnosis[1]
- allergen testing
Radiology
- computed tomography (coronal sinus CT)
- visualization of ethmoid sinuses
- 90-100% sensitivity, 60% specificity
- method of choice
- magnetic resonance imaging
Complications
- sinonasal inflammation associated with decreased brain connectivity within a major functional hub with a central role in modulating cognition[7]
Differential diagnosis
Management
- non-pharmaceutical measures:
- pharmaceutical agents
- nasal corticosteroids plus saline irrigation 1st line[3]
- sinusitis with nasal polyps
- leukotriene antagonists as maintenance
- nasal glucocorticoids 1st line[10]
- systemic glucocorticoids as rescue therapy[3]
- sinusitis without nasal polyps
- antibiotics guided by sinus aspiration & culture
- 4-6 weeks of macrolide therapy
- shorter duration of other antibiotics[3]
- antifungal agents not recommended[2] except in cases of allergic fungal sinusitis with polyposis[9]
- referral to otolaryngologist
- endoscopic sinus surgery (also see patient information)
- improves sleep & quality of life in patients with chronic rhinosinusitis[4]
- good short-term relief, but minimally effective at 1 year for patients with chronic rhinosinusitis with nasal polyps[8]
- chronic invasive fungal sinusitis generally requires surgery
- endoscopic sinus surgery (also see patient information)
More general terms
More specific terms
- chronic ethmoidal sinusitis
- chronic frontal sinusitis
- chronic hyperplastic sinusitis
- chronic maxillary sinusitis
- chronic sphenoidal sinusitis
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 Ferguson BJ et al. Prospective observational study of chronic rhinosinusitis: Environmental triggers and antibiotic implications. Clin Infect Dis 2012 Jan 1; 54:62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22114094
- ↑ Jump up to: 2.0 2.1 2.2 Rosenfeld RM et al Clinical Practice Guideline (Update). Adult Sinusitis Executive Summary. Otolaryngol Head Neck Surg April 2015 vol. 152 no. 4 598-609 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25833927 <Internet> http://oto.sagepub.com/content/152/4/598.full
- ↑ Jump up to: 3.0 3.1 3.2 3.3 Rudmik L, Soler ZM. Adult Chronic Sinusitis. JAMA. 2015 Sep 1;314(9):964 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26325574
Rudmik L, Soler ZM Medical Therapies for Adult Chronic Sinusitis. A Systematic Review. JAMA. 2015;314(9):926-939 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26325561 <Internet> http://jama.jamanetwork.com/article.aspx?articleID=2432168 - ↑ Jump up to: 4.0 4.1 Alt JA et al. Quality of life in patients with chronic rhinosinusitis and sleep dysfunction undergoing endoscopic sinus surgery: A pilot investigation of comorbid obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2015 Sep 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26356240
- ↑ Jump up to: 5.0 5.1 Little P, Stuart B, Mullee M et al Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial. CMAJ July 18, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27431306 <Internet> http://www.cmaj.ca/content/early/2016/07/18/cmaj.160362
- ↑ Bachert C, Han JK, Desrosiers M et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019 Sep 19; S0140-6736(19)31881-1; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31543428
Stevens WW. A new treatment for chronic rhinosinusitis with nasal polyps. Lancet 2019 Sep 19; S0140-6736(19)32133-6; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31543427 - ↑ Jump up to: 7.0 7.1 Jafari A, de Lima Xavier L, Bernstein JD et al Association of Sinonasal Inflammation With Functional Brain Connectivity. JAMA Otolaryngol Head Neck Surg. 2021;147(6):534-543 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33830194 PMCID: PMC8033506 (available on 2022-04-08) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2778439
- ↑ Jump up to: 8.0 8.1 Lourijsen ES et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: A multicentre, randomised, controlled trial. Lancet Respir Med 2022 Apr; 10:337. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35012708 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00457-4/fulltext
- ↑ Jump up to: 9.0 9.1 Archer SM, Meyers AD Nonsurgical Treatment of Nasal Polyps.. Medscape. April 1, 2021 https://emedicine.medscape.com/article/861353-treatment
- ↑ Jump up to: 10.0 10.1 NEJM Knowledge+