Chronic sinusitis
Updates to Article Attributes
Chronic sinusitis refers to ongoing long-term sinus infection-inflammation that often develops secondary to a prolonged/refractory acute sinus infection.
Epidemiology
It most commonly affects young to middle-aged adults but can uncommonly also affect children.
Clinical presentation
Chronic sinusitis is defined clinically as a sinonasal infection lasting more than 12 weeks. Patients may present with symptoms of sinusitis such as nasal obstruction, nasal discharge, facial pain, headache, halitosis, anosmia, etc.
It is worth noting is no definite correlation between symptoms and imaging findings of chronic sinusitis and that endoscopic chronic sinusitis may have no imaging correlation as the mucosa is best appreciated on the former 11.
Pathology
Aetiology
-
deviated nasal septum - sinonasal polyposis
-
sinus anatomy distortion that may be congenital or from prior traumachronic allergy -
chronic infection:
- chronic bacterial sinusitis
-
chronic allergic
reactions
A study was done on 150 patients of chronic rhinosinusitis and found the following anatomical variants 10:
- concha bullosa (30%)
- posterior nasal septal deviations (25%)
- uncinate process variations (25%)
- paradoxical middle turbinate (10%)
- agger nasi cells (10%)
- Haller cells (9%)
Radiographic features
CT
A characteristic feature on CT sinuses is sclerotic thickened bone (hyperostosis) involving the sinus wall from a prolonged mucoperiosteal reaction. Intrasinus calcification may be present. The presence of opacification is not a good distinguisher from an acute sinus infection.
Treatment and prognosis
A study was done on 150 patients ofchronic rhinosinusitisand found the following anatomical variants10:-
concha bullosa(30%) posterior nasal septal deviations (25%)-
uncinate processvariations (25%) -
paradoxical middle turbinate(10%) -
agger nasi cells(10%) -
Haller cells(9%)
Functional endoscopic sinus surgery (FESS) has revolutionised the approach and treatment of chronic rhinosinusitis. Certain anatomical variations are thought to be predisposing factors for the development of sinus disease and it is necessary for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS 10.
-<p><strong>Chronic sinusitis</strong> refers to ongoing long-term sinus infection-inflammation that often develops secondary to a prolonged/refractory <a href="/articles/acute-sinusitis">acute sinus infection</a>.</p><h4>Epidemiology</h4><p>It most commonly affects young to middle-aged adults but can uncommonly affect children.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>-<li><a href="/articles/deviated-nasal-septum">deviated nasal septum</a></li>- +<p><strong>Chronic sinusitis</strong> refers to ongoing long-term sinus infection-inflammation that often develops secondary to a prolonged/refractory <a href="/articles/acute-sinusitis">acute sinus infection</a>.</p><h4>Epidemiology</h4><p>It most commonly affects young to middle-aged adults but can uncommonly also affect children.</p><h4>Clinical presentation</h4><p>Chronic sinusitis is defined clinically as a sinonasal infection lasting more than 12 weeks. Patients may present with symptoms of sinusitis such as nasal obstruction, nasal discharge, facial pain, headache, halitosis, anosmia, etc.</p><p>It is worth noting is no definite correlation between symptoms and imaging findings of chronic sinusitis and that endoscopic chronic sinusitis may have no imaging correlation as the mucosa is best appreciated on the former <sup>11</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>
- +<li>paranasal sinus anatomical variants obstructing drainage (see below)</li>
-<li>sinus anatomy distortion that may be congenital or from prior trauma</li>-<li>allergic reactions<ul><li><a href="/articles/fungal-sinusitis">fungal sinusitis</a></li></ul>- +<li>chronic allergy</li>
- +<li>chronic infection:<ul>
- +<li>chronic bacterial sinusitis</li>
- +<li>chronic <a title="Allergic fungal sinusitis" href="/articles/allergic-fungal-sinusitis">allergic fungal sinusitis</a>
-</ul><h4>Radiographic features</h4><h5>CT</h5><p>A characteristic feature on CT sinuses is sclerotic thickened bone involving the sinus wall from a prolonged mucoperiosteal reaction. <a href="/articles/intrasinus-calcification">Intrasinus calcification</a> may be present. The presence of opacification is not a good distinguisher from an acute sinus infection.</p><h4>Treatment and prognosis</h4><p>A study was done on 150 patients of <a href="/articles/chronic-sinusitis">chronic rhinosinusitis</a> and found the following anatomical variants <sup>10</sup>:</p><ul>- +</ul>
- +</li>
- +</ul><p>A study was done on 150 patients of chronic rhinosinusitis and found the following anatomical variants <sup>10</sup>:</p><ul>
-<a href="/articles/uncinate-process">uncinate process</a> variations (25%)</li>- +<a href="/articles/uncinate-process">uncinate process</a> variations (25%)</li>
-<a href="/articles/paradoxical-middle-turbinate">paradoxical middle turbinate</a> (10%)</li>- +<a href="/articles/paradoxical-middle-turbinate">paradoxical middle turbinate</a> (10%)</li>
-</ul><p><a href="/articles/functional-endoscopic-sinus-surgery-1">Functional endoscopic sinus surgery (FESS)</a> has revolutionised the approach and treatment of chronic rhinosinusitis. Certain <a href="/articles/functional-endoscopic-sinus-surgery-preoperative-variants-mnemonic">anatomical variations</a> are thought to be predisposing factors for the development of sinus disease and it is necessary for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS <sup>10</sup>.</p>- +</ul><h4>Radiographic features</h4><h5>CT</h5><p>A characteristic feature on CT sinuses is sclerotic thickened bone (hyperostosis) involving the sinus wall from a prolonged mucoperiosteal reaction. <a href="/articles/intrasinus-calcification">Intrasinus calcification</a> may be present. The presence of opacification is not a good distinguisher from an acute sinus infection.</p><h4>Treatment and prognosis</h4><p><a href="/articles/functional-endoscopic-sinus-surgery-1">Functional endoscopic sinus surgery (FESS)</a> has revolutionised the approach and treatment of chronic rhinosinusitis. Certain <a href="/articles/functional-endoscopic-sinus-surgery-preoperative-variants-mnemonic">anatomical variations</a> are thought to be predisposing factors for the development of sinus disease and it is necessary for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS <sup>10</sup>.</p>
References changed:
- 11. Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed endoscopic sinus surgery: spectrum of CT findings in the frontal recess. (2009) Radiographics : a review publication of the Radiological Society of North America, Inc. 29 (1): 177-95. <a href="https://doi.org/10.1148/rg.291085118">doi:10.1148/rg.291085118</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19168844">Pubmed</a> <span class="ref_v4"></span>
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