Sinusitis
Basics
Description
- Sinusitis is inflammation of the mucous membranes lining the paranasal sinuses.
- The term is most commonly used to describe bacterial rhinosinusitis, which is a clinical diagnosis made by the presence of upper respiratory tract symptoms that have not improved in 10 days or have worsened after 5 to 7 days. Sinusitis may be classified in a number of ways.
- Classification based on duration of symptoms:
- Acute: persistent nasal and sinus symptoms for 10 to 30 days; worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement; or concurrent high fever and purulent nasal discharge for the first 3 to 4 days of an acute upper respiratory infection (URI)
- Subacute: clinical symptoms for 30 to 90 days
- Chronic: symptoms lasting >90 days
- Recurrent: acute sinusitis with 10 days of complete resolution between episodes; three episodes in 6 months or four in 1 year
- Classification by severity of illness:
- Persistent acute: >10 to 14 days but <30 days; nasal discharge and/or daytime cough
- Severe acute: temperature of ≥39°C (102.2°F) with concurrent purulent nasal discharge for ≥3 days and/or facial pain, headache, or periorbital edema
- Classification based on duration of symptoms:
General Prevention
- Avoid allergen exposure and treat allergies if present.
- Improve mucociliary clearance by increasing ambient humidity with a humidifier.
Pathophysiology
- Normal sinus function depends on patency of paranasal sinus ostia, function of the ciliary apparatus, and secretion quality.
- Secretions accumulate due to ostial obstruction, reduction in ciliary function, and overproduction.
- Viral URIs and/or allergic rhinitis often precede(s) acute bacterial sinusitis.
- Acute bacterial sinusitis is a complication of 5–10% of URIs.
Etiology
- Viral pathogens (e.g., rhinovirus, parainfluenza virus) are often recovered in respiratory isolates.
- Most illnesses of short duration (<7 days) are thought to be due to viral infection and therefore should not be treated with antibiotics.
- Chronic sinusitis is often secondary to allergic rhinitis, cystic fibrosis, environmental pollutants, or gastroesophageal reflux.
- Most common bacterial pathogens:
- Haemophilus influenzae, nontypeable (with Streptococcus pneumoniae, make up 30% of cases)
- S. pneumoniae
- Moraxella catarrhalis (10% of cases)
- Other bacterial pathogens:
- Group A streptococci
- Group C streptococci
- Peptostreptococci
- Other Moraxella species
- Streptococcus viridans
- Eikenella corrodens
- Staphylococcus aureus (infrequent but significant pathogen in orbital and intracranial complications)
- Pseudomonas aeruginosa (in patients with cystic fibrosis)
- Anaerobic organisms
- Polymicrobial
- Fungal pathogen: Aspergillus
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Citation
Cabana, Michael D., editor. "Sinusitis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617249/all/Sinusitis.
Sinusitis. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617249/all/Sinusitis. Accessed November 2, 2024.
Sinusitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617249/all/Sinusitis
Sinusitis [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 November 02]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617249/all/Sinusitis.
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