Introduction
Chronic rhinosinusitis affects up to 1 in 10 people. It is generally defined as an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.
Epidemiology
- Incidence: 500.00 cases per 100,000 person-years
- Peak incidence: 30-40 years
- Sex ratio: 1:1
| Condition | Relative incidence |
|---|---|
| Chronic rhinosinusitis | 1 |
| Nasal polyps | 0.20 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Aetiology
Predisposing factors include:
- atopy: hay fever, asthma
- nasal obstruction e.g. Septal deviation or nasal polyps
- recent local infection e.g. Rhinitis or dental extraction
- swimming/diving
- smoking
Clinical features
Features
- facial pain: typically frontal pressure pain which is worse on bending forward
- nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
- nasal obstruction: e.g. 'mouth breathing'
- post-nasal drip: may produce chronic cough
Management
Management of recurrent or chronic sinusitis
Red flags symptoms
- avoid allergen
- intranasal corticosteroids
- nasal irrigation with saline solution
Red flags symptoms
- unilateral symptoms
- persistent symptoms despite compliance with 3 months of treatment
- epistaxis