Sinusitis disease? Sinusitis sinus infection and treatment 

There are so many searches about sinusitis disease on the internet. In this post, we will share some knowledge about sinusitis and discuss bacterial sinusitis also.

In this post, we will discuss the following topic. This topic also helps you to get more information about sinusitis disease.

1. The classification of rhino-sinusitis disease
2. Etiology of sinusitis disease
3. Acute bacterial rhinosinusitis disease
4. Acute bacterial rhinosinusitis disease
5. Bacteriology of sinusitis disease
6. Pathogenesis of acute rhinosinusitis disease
7. Pathogenesis of acute bacterial sinusitis disease
8. Diagnostic criteria for acute rhinosinusitis disease
9. Treatment of  acute rhinosinusitis disease

But nowadays the term sinusitis is replaced by the term rhino-sinusitis. It because in most of the cases where there is inflammation of the sinuses the nose is also involved. 

So rhino-sinusitis is the inflammation or infection of both the nose and the sinuses. If we look into the definition proper of rhino-sinusitis, it is a group of disorders that is characterized by symptomatic inflammation of the mucosa of the paranasal sinuses.

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The classification of rhino-sinusitis disease 

Sinusitis disease can be classified into two parts based on time and symptomatology. These are as follows.

The timeframe 

That means the temporal prime frame from the onset of the symptoms, based on the duration of the symptoms. 

And the other way of classification of the rhino-sinusitis disease is based on 

The symptomatology 

Based on the symptomatology the disease is classified into two 

• major symptoms and
• minor symptoms.

Classification of the rhino-sinusitis disease based on the time frame 

So it is classified into mainly four groups 

1. The first is acute rhinosinusitis disease  
2. Recurrent acute rhinosinusitis disease  
3. Subacute rhinosinusitis disease  and the last is 
4. The chronic rhino disease sinusitis 

The acute rhinosinusitis disease:- 

when the inflammation or infection of the nose and the paranasal sinuses is sudden onset and the duration of the symptom is less than four weeks it is called acute rhino-sinusitis.

 Recurrent acute rhinosinusitis disease:-

When the patient suffers from four or more attacks of acute rhinosinusitis in one year and each episode lasts for seven to ten days.

Subacute rhinosinusitis disease:-

The third subcategory is subacute rhinosinusitis, where the duration of the symptoms may range from four to twelve weeks a disease.

Chronic rhinosinusitis:-

Where the symptoms last for more than 12 consecutive weeks it is labeled as chronic rhinosinusitis. 

The classification of rhinosinusitis disease based on the symptomatology

This classification is also further divided into two parts which are as follows. 

1. Major symptoms and
2. Minor symptoms.

The major symptoms 

• Symptom of facial pain or facial pressure
• A sensation of facial condition fullness
• Nasal blockage 
• Purulent laser discharge or posterior purulent discharge
• Hyposmia /anosmia means the disorders of the infection 
• The purulence is identified on the nasal examination and 
• Fever is a major symptom only in cases of acute rhinosinusitis.

The minor symptoms

• Among the minor symptoms are the symptoms like 
• Headache 
• Fever in non-acute rhinosinusitis
• Halitosis 
• Fatigue 
• Dental pain 
• Cough and associated ear symptoms like earache and ear fullness. 

So acute rhinosinusitis disease in this post I will be talking only on acute rhinosinusitis. It denotes the symptoms when they are sudden onset and the duration is less than four weeks.

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Etiology of acute rhinosinusitis disease

If we look into the etiology the cause is always almost always infections. The most common predisposing in infection is in most cases is viral. 

It can be due to bacterial and fungal infection, in the majority, it is always secondary to the viral infection. It could be in fungal etiology the fungal etiology we are not discussing in this post because it will be is discussed in detail in the next post on the fungal rhinosinusitis disease. 

The majority of the cases of acute rhinosinusitis are self-limiting because it is caused by viral infection and bacterial infections. 

Acute bacterial rhinosinusitis 

They occur secondary to the viral infections now what is acute bacterial rhinosinusitis or in short form, it is called a BRS. 

How it is different from acute rhinosinusitis?

So definitely the etiology, when it is bacterial we label it as acute bacterial. But how it is labeled as acute bacterial? 

Acute bacterial rhinosinusitis disease

So acute rhinosinusitis disease is when is suspected as acute bacterial sinusitis after at least a patient is having 7 to 10 days of symptoms or if the symptoms worsen after five to seven days of onset.

So in the beginning, if a patient is coming to you with the symptoms within a period of say about 7 to 10 days then it is considered as a viral etiology and it is considered to be bacterial only when the symptoms persist for this mentioned period of days.

Bacteriology of acute rhinosinusitis disease

In adults

If we look into the microbiology of acute bacterial sinusitis the most common bacteria which is responsible in an adult is streptococcus pneumonia.

In children

In children, microbiology is a little bit different. These are due to H.influenza and  M. Catarrhalis.

Staphylococcus aureus mainly methicillin-resistant Staphylococcus aureus is a big concern nowadays.

Predisposing factors of acute rhinosinusitis disease

So we know that acute rhinosinusitis is the inflammation or infection of the paranasal sinuses in the nose, but there are certain predisposing factors let’s see one by one.

• The most important predisposing factor is the viral upper respiratory tract infection. 
• allergy is also suggested but still, it is not proven but it is considered to play a role in the development of acute rhinosinusitis. 
• next is the anatomical deformities like septal deformity
• immune and 
• the role of environmental factors 

Pathogenesis of acute rhinosinusitis disease

If we look into the pathogenesis of acute rhinosinusitis remember that the pathophysiology of the acute rhinosinusitis disease is an interplay between the predisposing factors like viral upper respiratory tract infection, it could be an allergy or any anatomical variations and the other being the infection and the inflammation in the sinonasal mucosa. 

So if due to any reason there is an inflammation of the paranasal sinuses, it will lead to infection of the paranasal sinuses. 

It is seen that if there is an infection of the paranasal sinuses it will cause inflammation of the mucosa of the sinuses, so basically they are interlinked with each other.

Pathogenesis of acute bacterial sinusitis disease

To understand the pathogenesis of acute bacterial sinusitis we must know how the individual predisposing factors cause the symptoms. 

• The most important being the viral upper respiratory tract infection so after an attack of viral upper respiratory tract infection, there is seen that there occurs the mucosal swelling of the nose and the paranasal sinuses. 
• Because of this, there is an obstruction of the sinus Ostia. When there is obstruction of the sinus Ostia definitely the drainage of fluid occurs in the sinus. It does seem that or it predisposes to acute bacterial sinusitis in two ways. 
• First of all, there is a transudation of the fluid in the sinuses and another way when the sinus Ostia gets a blow. 
• There is reduced oxygen inside the sinuses and as a result of which it is seen that there is a reduction in the mucociliary clearance. 
• Because of this mucosal thickening then there is a stasis of the fluid is inside the sinus. Moreover, on top of that, the fluid is not able to get cleared because of the defect in the mucociliary clearance and it promotes bacterial infection. 

The other way by which the viral upper respiratory tract infection promote infection to the pick is 

• After the viral infection, the mucus becomes more viscous thick. As a result of the change in the consistency of the mucus, there is again reduced mucociliary transport. 
• Which leads to obstructive sinuses and it leads to the predisposes to the development of secondary bacterial infection. 

Allergy in acute bacterial sinusitis disease

• The rule of allergy in acute bacterial sinusitis is suggested but it is not proved until now. It is seen that if there is any allergic reaction there will be an antigen-antibody reaction. 
• This leads to the release of inflammatory mediators and as a result of these inflammatory, there is a change in the permeability of the vasculature.
• There is the destabilization of the lysosomal membrane so all this results in inflammatory changes which ultimately lead causes ostial blockage. 
• And because of the ostium blockage, it predisposes to the development of acute bacterial rhinosinusitis.

Diagnosis of acute bacterial sinusitis disease. 

History taking

Now how to diagnose acute rhinosinusitis the most important is the history-taking of a patient. The type of symptoms whether the symptoms are major or minor and the duration it matters. 

Nasal endoscopy examination

Next is after a proper history taking the next examination which helps to diagnose is the nasal endoscopy examination. 

• It is done to assess the middle meatus and 
• Especially the sphenoid module

Moreover in cases of severe disease when there is a purulent discharge if it can be seen then this purulent discharge is taken for culture and sensitivity testing.

The radio imaging studies CT PNS is preferred

They also help in the diagnosis and a CT scan of the paranasal sinuses is preferred.

But the most crucial job is for the clinician to differentiate the acute bacterial sinusitis from viral rhinosinusitis.

we required acute rhinosinusitis disease is suspected when the symptoms last for less than 10 days, and acute bacterial rhinosinusitis is considered when the symptoms last more than 10 days or they worsen after an initial improvement of 5 to 7 days. 

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Diagnostic criteria for acute rhinosinusitis disease

There is a guiding guideline by the clinical practice guidelines for acute rhinosinusitis disease. Under this diagnostic criteria guidelines it includes;

That if a patient is having up to four weeks of purulent nasal discharge which is accompanied by the other symptoms like 

• Nasal obstruction 
• facial pain facial pressure fullness or both 
• Then it is suggestive of acute rhinosinusitis disease
• Moreover, this purulent nasal discharge may be reported by the patient or it may be observed on physical examination.
• Likewise regarding the nasal obstruction according to the guidelines it is seen that it may be reported by the patient or it may be observed on physical examination.
• CT scan of the patient help in the diagnosis

Treatment of  Acute rhinosinusitis disease.

Now let’s come into the treatment of acute rhinosinusitis disease. The goal of the treatment is the first and important is to minimize the symptoms

• To reduce the inflammation 
• Eradicate the pathogens 
• Acute bacterial sinusitis facilitates sinus drainage because it is ultimately happening after the sinus Ostia blockage. 
• And determine the severity of the symptoms too because based on the severity of the symptoms only the treatment is planned. 

Recommended therapy in acute rhinosinusitis disease based on the severity 

Now let’s see the recommended therapy in acute and sinusitis based on the severity according to the severity the patients are divided into three groups. 

1. Mild 
2. Moderate and
3. Severe 

Mild acute rhinosinusitis disease the treatment guidelines 

Treatment suggests the patient must be given symptomatic treatment only and watchful waiting under the symptomatic treatment it includes;

• Prescribing the Analgesic 
• Antipyretics 
• Decongestants 
• Nasal irrigation to clean the nasal secretions inside the nose and 
• Last is the steam inhalation if a patient 

Moderate acute rhinosinusitis disease

It falls into the category of moderate acute rhinosinusitis disease the treatment is the symptomatic treatment as prescribed for the mild acute rhinosinusitis is grow. Then if the symptoms persist for five days then;

• Add intranasal steroids for 5 days
• Consider adding the antibiotic after 5 to 14 days
• And if the patient is not getting okay after 14 days then reconsider your diagnosis and do a repeat nasal endoscopy. 

Severe acute rhinosinusitis disease

In a case of severe acute rhinosinusitis disease, the pre recommended therapy is using 

• Intranasal steroid 
• Antibiotics 
• Oral corticosteroids are prescribed to reduce the pain in the severe disease and remember if there is no improvement in 48 hours 
• Consider a nasal endoscopy plan for radiological investigations like a CT scan. 
• And sometimes in very severe cases, we need to give intravenous antibiotics
• Also and if a patient is having morbid allergic rhinitis then you can add oral antihistamine.

Conclusion

Time to conclude the session with the last few words about sinusitis disease. We hope that this article will help you a lot to understand acute sinusitis. You can also read our other blog post on mental health as well as about pregnancy-related stuff. 

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If you have any queries about sinusitis disease you can also let us know about it in the comment section below. We will definitely try to solve it.