Sinusitis (Chronic)

Question 1

What is chronic sinusitis?

Answer 1

Inflammation of the paranasal sinuses lasting more than 12 weeks.

Question 2

What pathogens cause chronic sinusitis?

Answer 2

• Staphylococcus aureus
• Gram-negative rods
• Haemophilus influenzae
• Group A streptococcus
• Streptococcus pneumoniae

Question 3

What are the risk factors for chronic sinusitis?

Answer 3

• Ciliary dysfunction
• Aspirin sensitivity
• Allergic rhinitis
• Airway hyperreactivity/asthma
• Previous sinus injury
• Immunodeficiency

Question 4

What are the signs of chronic sinusitis?

Answer 4

• N

Question 5

What are the symptoms of chronic sinusitis?

Answer 5

• Facial pain and pressure
• Nasal obstruction
• Nasal discharge or post-nasal drip
• Purulence
• Headache

Question 6

What investigations should be ordered for chronic sinusitis?

Answer 6

• Anterior rhinoscopy
• Nasal endoscopy
• Sinus CT

Question 7

Why investigate using anterior rhinoscopy? And what may this show?

Answer 7

• Initial physical examination, both in primary care clinic and by specialist.
• Polyps, purulence from middle meatus or structural abnormalities may be seen.

Question 8

Why investigate using nasal endoscopy? And what may this show?

Answer 8

• Performed by an ear, nose and throat physician in the clinic setting after nasal decongestion.
• Polyps, gross purulence or structural obstruction may be seen.

Question 9

Why investigate using CT? And what may this show?

Answer 9

• CT scan without contrast confirms diagnosis. It should be ordered to confirm and stage chronic sinusitis in patients who fail maximal medical management.
• Opacification of involved sinuses, mucosal thickening, air-fluid levels or anatomical abnormalities.

Question 10

Briefly describe the treatment for chronic sinusitis

Answer 10

• Nasal saline irrigation
• Intranasal corticosteroid
• Antibiotic therapy
• Decongestant

Question 11

When is antibiotic therapy appropriate in treating chronic sinusitis?

Answer 11

• Oral antibiotics may be considered depending on examination/endoscopic findings, and response to initial treatment. If used, antibiotics should ideally be based on cultures.
• Evidence is limited.

Question 12

What complications are associated with chronic sinusitis?

Answer 12

• Orbital cellulitis
• Intracranial infection
• Mucocele
• Decreased quality of life

Question 13

What differentials should be considered in chronic sinusitis?

Answer 13

• Acute sinusitis
• Allergic rhinitis
• Allergic fungal sinusitis
• Sinonasal tumours

Question 14

How does chronic sinusitis and acute sinusitis differ?

Answer 14

• Signs and symptoms: no symptoms or signs reliably differentiate acute from chronic sinusitis. Both present in a similar fashion, although symptoms are generally less pronounced in chronic sinusitis. The distinction between the 2 is based upon the duration of symptoms (≤4 weeks versus ≥12 weeks, respectively).
• Investigations: no differentiating tests.

Question 15

How does chronic sinusitis and allergic rhinitis differ?

Answer 15

• Signs and symptoms: clear rhinorrhoea, itching, sneezing, ocular irritation and seasonality of symptoms suggest a predominant allergic component.
• Investigations:

Question 16

How does chronic sinusitis and allergic fungal sinusitis differ?

Answer 16

• Signs and symptoms: similar symptoms; often unilateral.
• Investigations: CT scan shows hyperdensities within opacified sinuses.

Question 17

How does chronic sinusitis and sinonasal tumours differ?

Answer 17

• Signs and symptoms: can occur in the sinuses, nasal cavity, or nasopharynx. Treatment for chronic sinusitis usually fails; symptoms are often unilateral and refractory. Constitutional symptoms may be present.
• Investigations: CT/MRI may show invasion or destruction of nearby structures that is suspicious for malignancy. Biopsy/tissue histology may reveal malignant cells.