Materiały źródłowe

• #1 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute sinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis. When this occurs, bacteria can remain in, gain access to, and proliferate within the usually sterile paranasal sinuses. Severe complications can occur when the sinus infection spreads to surrounding structures, such as the brain and orbit, via the valve-less diploic veins. These are veins located within the inner cancellous bone layer of the skull. This is thankfully a rare phenomenon, but important to remember. […]

• #1 Sinusitis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/sinusitis/

  Most important pathophysiological change: obstruction of sinus drainage. […] Normal metachronous movement of mucous toward the natural ostia of the sinuses is usually disrupted by mucosal inflammation stasis. […] Ciliary function impairment leads to a reduction in mucus drainage stasis. […] Stasis of secretions inside the sinuses leads to a proliferation of microorganisms. […] Alterations in the composition and quantity of mucus can also contribute to infection; increased mucus production is seen with asthma, rhinitis, and viral URIs.

• #1 Sinusitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

  Acute sinusitis in immunocompetent patients in the community is almost always viral (eg, rhinovirus, influenza, parainfluenza). A small percentage develop secondary bacterial infection with streptococci, pneumococci, Haemophilus influenzae, Moraxella catarrhalis, or staphylococci. […] In an upper respiratory infection (URI), the swollen nasal mucous membrane obstructs the ostium of a paranasal sinus, and the oxygen in the sinus is absorbed into the blood vessels of the mucous membrane. The resulting relative negative pressure in the sinus (vacuum sinusitis) is painful. If the vacuum is maintained, a transudate from the mucous membrane develops and fills the sinus; the transudate serves as a medium for bacteria that enter the sinus through the ostium or through a spreading cellulitis or thrombophlebitis in the lamina propria of the mucous membrane. An outpouring of serum and leukocytes to combat the infection results, and painful positive pressure develops in the obstructed sinus. The mucous membrane becomes hyperemic and edematous. […] Most acute sinusitis in immunocompetent patients is viral.

• #1 Sinus Infection (Sinusitis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17701-sinusitis

  Sinusitis is an inflammation, or swelling, of the tissue lining your sinuses. Sinuses are structures inside your face that are normally filled with air. Bacterial infections, viral infections and allergies can irritate them, causing them to get blocked and filled with fluid. This can cause pressure and pain in your face, nasal congestion (a stuffy nose) and other symptoms. […] Viruses, bacteria, fungi and allergens can cause sinusitis. Specific triggers for sinusitis include: The common cold. The flu (influenza). Streptococcus pneumoniae bacteria. Haemophilus influenza bacteria. Moraxella catarrhalis bacteria. Nasal and seasonal allergies. […] If you have a runny nose, stuffy nose and facial pain that dont go away after ten days, you might have bacterial sinusitis. Your symptoms may seem to improve but then return and are worse than the initial symptoms. Antibiotics and decongestants usually work well on bacterial sinusitis. […] Sinus infections caused by fungus are usually more serious than other forms of sinusitis. Theyre more likely to happen if you have a weakened immune system.

• #1

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  The most common cause of acute sinusitis is an upper respiratory tract infection (URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that usually resolves without treatment in less than 14 days. If symptoms worsen after 3 to 5 days or persist for longer than 10 days and are more severe than normally experienced with a viral infection, a secondary bacterial infection is diagnosed. The inflammation can predispose to the development of acute sinusitis by causing sinus ostial blockage. […] The nasal mucosa responds to the virus by producing mucus and recruiting mediators of inflammation, such as white blood cells, to the lining of the nose, which cause congestion and swelling of the nasal passages. The resultant sinus cavity hypoxia and mucus retention cause the cilia which move mucus and debris from the nose to function less efficiently, creating an environment for bacterial growth.

• #1 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #1 Recent Advances in Understanding the Pathophysiology of Rhinosinusitis | Ento Key

  https://entokey.com/recent-advances-in-understanding-the-pathophysiology-of-rhinosinusitis/

  Rhinosinusitis is a disease with a multifactorial etiology and hence diverse phenotypes. […] Several endogenous factors, such as anatomical abnormalities, humoral and cellular immune disorders, including allergy, hormonal factors, and acquired or congenital disturbances of the mucociliary clearance, have all been associated with the development and/or chronicity of rhinosinusitis. […] In addition, external factors, such as microbial agents causing infection and/or colonization, and iatrogenic factors may underlie the development of rhinosinusitis. […] Symptomatic inflammation of the sinonasal mucosa is the diagnostic criterion for defining rhinosinusitis. […] Normal mucociliary flow is a significant defense mechanism in the prevention of ARS. […] The impaired mucociliary function during viral rhinosinusitis results in an increased sensitivity to bacterial infection.

• #1 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. […] Failure of normal mucus transport and decreased sinus ventilation are the major factors contributing to the development of sinusitis. Obstruction of the sinus ostia occurs with mucosal edema or any anatomic abnormality that interferes with drainage. Bacterial and viral infections also impair the mucus transport system. The frequency of ciliary beats (normally 700 per minute) decreases to less than 300 per minute during periods of infection. Inflammation causes 30 percent of the ciliated columnar cells to undergo metaplastic changes to mucus-secreting goblet cells. The obstruction and decreased transport results in stagnation of secretions, decreased pH and lowered oxygen tension within the sinus, creating an excellent culture medium for bacteria.

• #1 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  In rhinosinusitis, altered sinus secretions exacerbate the susceptibility to persistent infection and subsequent inflammation. Normally, the mucous blanket in the respiratory tract consists of 2 distinct layers: the periciliary liquid phase, a thin, low-viscosity layer surrounding the cilia shaft allowing free ciliary movement, and the gel phase, a more viscous layer atop the periciliary liquid. In the presence of inflammation, derangements in the mucous layer separation can impair ciliary movement by disrupting the usual low-viscosity environment. […] Additionally, bacterial biofilms contribute to sinusitis pathogenesis, although they are more prevalent in chronic cases rather than in RARS. Biofilms hinder antibiotic penetration because bacteria within this layer are not only attached firmly to one another as well as their substrate but they are also surrounded by a protective proteinaceous or polysaccharide matrix. S aureus, notably, is adept at producing biofilms, which often require chemical and possibly mechanical disruption for definitive infection clearance.

• #1 Pulsenotes | Acute rhinosinusitis

  https://app.pulsenotes.com/surgery/ent/notes/acute-rhinosinusitis

  Acute rhinosinusitis is most commonly due to an upper respiratory tract viral pathogen. […] Acute rhinosinuitis is most commonly caused by viruses, although a small percentage (0.5-2%) are due to bacterial infections. […] Direct contact between an infective viral pathogen and the nasal or conjunctival mucosa can lead to viral replication and symptoms within the first day of inoculation. It is suspected that nose blowing then prompts propagation of the infection to the paranasal sinuses. As the infection develops it leads to excess sinonasal secretions, increased vascular permeability and mucosal oedema. […] Bacterial rhinosinusitis usually occurs as a secondary infection in an already inflamed sinus cavity. Thus, it can be thought about as one of the complications of viral rhinosinusitis. It can also occur secondary to any condition that effects drainage of the sinonasal passages (e.g. foreign body, cystic fibrosis) or impaired local immune responses (e.g. dental abscess). […] Complicated rhinosinusitis refers to extension of the infection beyond the nasal cavities and paranasal sinuses. This extension can lead to significant complications that require urgent hospital admission for treatment.

• #1 Rhinosinusitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinosinusitis_pathophysiology

  The pathophysiology for both acute and chronic rhinosinusitis involves blockage of the nasal sinuses and inflammation of the nasal sinuses. However, biofilms play a role in the pathogenesis of chronic rhinosinusitis. […] Pathophysiology of acute rhinosinusitis could be explained by several mechanisms: Anatomic variants: Since imaging modalities are not necessary for uncomplicated ARS, there aren’t enough evident regarding the contribution of anatomy to the pathogenesis of ARS. However, several contributing factors have been proposed: Anomalies of the unicate and middle turbinate, Stenosis of the infundibulum, Recirculation phenomenon, Infraorbital ethmoid cells, Nasoseptal deviation. […] Allergy: Allergens trigger the recruitment of eosinophils into the maxillary sinus causing inflammation.

• #1 Sinusitis-Acute and Chronic – Brigham and Women’s Faulkner Hospital

  https://www.brighamandwomensfaulkner.org/programs-and-services/otolaryngology/nose-conditions/sinusitis-acute-and-chronic

  A sinus infection often follows an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can lead to obstruction of the opening of the paranasal sinuses, which can lead to infection in the sinuses. […] Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus.

• #1 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  Anatomical variations that narrow the ostiomeatal complex, including septal deviation, paradoxical middle turbinates, and Haller cells, make this area more sensitive to obstruction from mucosal inflammation. Mechanical obstruction of the ostiomeatal complex from foreign bodies, polyps, or tumors can also result in acute sinus disease. Systemic diseases that result in decreased mucociliary clearance, including cystic fibrosis and Kartagener syndrome, can be predisposing factors for acute sinusitis in rare cases. Patients with immunodeficiencies (eg, agammaglobulinemia, combined variable immunodeficiency, and immunodeficiency with reduced immunoglobulin G [IgG] and immunoglobulin A [IgA]bearing cells) are also at increased risk of developing acute sinusitis. […] Ciliary function is also reduced in the presence of low pH, anoxia, bacterial toxins, smoking, dehydration, foreign bodies, and drugs (eg, atropine, antihistamines, phenylephedrine). Approximately 10% of cases of acute sinusitis result from direct inoculation of the sinus with a large amount of bacteria. Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Facial trauma or large inoculations from swimming can produce sinusitis as well.

• #1 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  A number of factors can contribute to the development of sinusitis. The most common cause of acute bacterial sinusitis is a viral upper respiratory infection. Up to 0.5 percent of upper respiratory infections in adults develop into documented sinusitis. Children experience six to eight colds per year, and approximately 5 to 10 percent of these infections are complicated by sinusitis. Allergic rhinitis has also been considered a contributing factor to sinusitis; however, no causal relationship has been proved, and it is now believed to be a rare initiating factor. Iatrogenic factors include mechanical ventilation, nasogastric tubes, nasal packing and dental procedures. Pregnancy, hormone changes associated with puberty, and senile rhinorrhea may be contributing factors. Anatomic variations include tonsillar and adenoid hypertrophy, deviated septum, nasal polyps and cleft palate.

• #1 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Viruses are the most common cause of acute rhinosinusitis. The viral rhinosinusitis (VRS) pathogens include rhinovirus, adenovirus, influenza virus, and parainfluenza virus. The most common causes of acute bacterial rhinosinusitis (ABRS) are Streptococcus pneumoniae (38%), Haemophilus influenzae (36%), and Moraxella catarrhalis (16%). […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis.

• #1 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Acute bacterial rhinosinusitis is most commonly viral. The large majority of cases will either resolve spontaneously or can be effectively treated with antibiotics. Invasive fungal rhinosinusitis is a rare, serious form of the infection that can occur in immunocompromised patients. It is associated with a high morbidity and mortality rate. […] Complications are rare, occurring in about 1 out of every 1000 cases. Sinus infections may spread to the orbit, bone, or intracranial cavities. Eighty percent of orbitocranial complications occur in the orbit. These complications can come with significant morbidity and mortality.

• #1 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  Acute sinusitis typically develops from a viral or bacterial infection of the paranasal sinuses leading to inflammation, edema, and ultimately obstruction of the sinus outflow tracts. […] Intracranial complications of sinusitis occur more commonly in children and are classically associated with adolescent males with spread of frontal sinus disease through the veins of Breschet which communicate directly with the dura. However, disease can also spread intracranially from other sites such as the ethmoid or sphenoid sinuses. Extension of the disease intracranially can lead to meningitis, superior sagittal sinus thrombosis, epidural abscess, subdural empyema or abscess, cerebral abscess, or frontal bone osteomyelitis (i.e., Potts puffy tumor). […] Imaging, most commonly CT with contrast, is indicated although MRI with and without contrast better differentiates subdural empyema or intracranial abscess from adjacent cerebritis and inflammation. Sampling from an involved sinus with endoscopic visualization or trephination (preferable in some cases of isolated frontal sinusitis in order to not disturb the mucosa of the outflow tract or when the degree of infection/inflammation makes endoscopic visualization challenging) can be helpful for identification and susceptibility of the responsible pathogen. ESS may also allow for better source control of the disease.

• #2 Acute Rhinosinusitis – Causes – Investigations – Management – TeachMeSurgery

  https://teachmesurgery.com/ent/nose/acute-rhinosinusitis/

  Acute rhinosinusitis is a common condition, affecting 8-15% of the population at any one time. It is characterised by acute inflammation of the mucosal linings of the nasal passage (rhinitis) and paranasal sinuses (sinusitis). […] There are a variety of precipitants for acute inflammation of nasal mucosa, such as infection and allergy. Inflammation of mucosa results in blockage of the paranasal sinuses and subsequently can lead to a bacterial infection. […] The most common causes are a viral organisms, such as rhinovirus, influenza, or adenovirus, however can also be caused by bacterial organisms, such as S. pneumoniae, H. Influenzae, or M. catarrhalis. […] Acute rhinosinusitis is inflammation of the mucosal linings of the nasal passage and paranasal sinuses.

• #2 Sinusitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/sinusitis/

  Sinusitis is triggered by three factors: obstruction of sinus drainage pathways (sinus ostia) due to mucosal edema, ciliary impairment, and altered mucus quantity and quality stasis of secretions inside the sinuses proliferation of various pathogens; sinusitis […] Recurrent, untreated/complicated acute sinusitis may lead to chronic sinusitis. […] Chronic rhinosinusitis without nasal polyps: Pathogenesis is associated with anatomical abnormalities (e.g., septal deviation, tumors) and dental disease (i.e., sinusitis of dental origin).

• #2 Acute sinusitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/symptoms-causes/syc-20351671

  Acute sinusitis causes the spaces inside the nose, known as sinuses, to become inflamed and swollen. […] Acute sinusitis is most often caused by the common cold. Signs and symptoms may include a blocked and stuffy (congested) nose, which may block your sinuses and prevent drainage of mucus. […] Acute sinusitis is an infection caused by a virus. The common cold is most often the cause. Sometimes, sinuses that are blocked for a time might get a bacterial infection.

• #2 A prospective study of acute sinusitis, clinical features and modalities of management in adults, Sudan | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-022-00316-9

  Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. […] The mucosal mucus-secreting goblet cell and the cilia are physiologically important. Their damage leads to the accumulation of fluid predisposing to infection. The typing and etiology of acute sinusitis follow the causative factors. The viral sinusitis lasting for less than 10 days and not worsening, rhinovirus, adenovirus, influenza virus, and parainfluenza virus are the commonest causes. The acute bacterial sinusitis last more than 10 days, commonly caused by Streptococcus pneumoniae, Hemophilus influenza, and Moraxella catarrhalis. The acute fungal though rare does occur and is more likely to occur in immunocompromised patients, typical causing species include mucor, rhizopus, reconductor, and aspergillus.

• #2 Pulsenotes | Acute rhinosinusitis

  https://app.pulsenotes.com/surgery/ent/notes/acute-rhinosinusitis

  Acute rhinosinusitis is most commonly due to an upper respiratory tract viral pathogen. […] Acute rhinosinuitis is most commonly caused by viruses, although a small percentage (0.5-2%) are due to bacterial infections. […] Direct contact between an infective viral pathogen and the nasal or conjunctival mucosa can lead to viral replication and symptoms within the first day of inoculation. It is suspected that nose blowing then prompts propagation of the infection to the paranasal sinuses. As the infection develops it leads to excess sinonasal secretions, increased vascular permeability and mucosal oedema. […] Bacterial rhinosinusitis usually occurs as a secondary infection in an already inflamed sinus cavity. Thus, it can be thought about as one of the complications of viral rhinosinusitis. It can also occur secondary to any condition that effects drainage of the sinonasal passages (e.g. foreign body, cystic fibrosis) or impaired local immune responses (e.g. dental abscess). […] Complicated rhinosinusitis refers to extension of the infection beyond the nasal cavities and paranasal sinuses. This extension can lead to significant complications that require urgent hospital admission for treatment.

• #2 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #2 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Healthy sinuses are composed of ciliated pseudostratified columnar epithelium, which uses cilia to clear the sinuses of debris, mucus, and other substances. The mucosal edema, infiltration of granulocytes and lymphocytes, squamous metaplasia, and fibroblast proliferation from acute rhinosinusitis disrupts this process. […] Acute rhinosinusitis is a clinical diagnosis. Three cardinal symptoms that are most sensitive and specific for acute rhinosinusitis are purulent nasal drainage accompanied by either nasal obstruction or facial pain/pressure/fullness. […] Severe symptoms are more indicative of a bacterial cause. These include high fevers (over 39 C or 102 F) accompanied by purulent nasal discharge or facial pain for three to four consecutive days at the beginning of the illness. […] The culture of endoscopic aspirates with greater than or equal to 10 CFU/mL is considered the gold standard. However, this is not necessary for diagnosis and not done for the vast majority of cases of ABRS.

• #2 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. […] Failure of normal mucus transport and decreased sinus ventilation are the major factors contributing to the development of sinusitis. Obstruction of the sinus ostia occurs with mucosal edema or any anatomic abnormality that interferes with drainage. Bacterial and viral infections also impair the mucus transport system. The frequency of ciliary beats (normally 700 per minute) decreases to less than 300 per minute during periods of infection. Inflammation causes 30 percent of the ciliated columnar cells to undergo metaplastic changes to mucus-secreting goblet cells. The obstruction and decreased transport results in stagnation of secretions, decreased pH and lowered oxygen tension within the sinus, creating an excellent culture medium for bacteria.

• #2 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  In rhinosinusitis, altered sinus secretions exacerbate the susceptibility to persistent infection and subsequent inflammation. Normally, the mucous blanket in the respiratory tract consists of 2 distinct layers: the periciliary liquid phase, a thin, low-viscosity layer surrounding the cilia shaft allowing free ciliary movement, and the gel phase, a more viscous layer atop the periciliary liquid. In the presence of inflammation, derangements in the mucous layer separation can impair ciliary movement by disrupting the usual low-viscosity environment. […] Additionally, bacterial biofilms contribute to sinusitis pathogenesis, although they are more prevalent in chronic cases rather than in RARS. Biofilms hinder antibiotic penetration because bacteria within this layer are not only attached firmly to one another as well as their substrate but they are also surrounded by a protective proteinaceous or polysaccharide matrix. S aureus, notably, is adept at producing biofilms, which often require chemical and possibly mechanical disruption for definitive infection clearance.

• #2 Sinusitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

  Acute sinusitis in immunocompetent patients in the community is almost always viral (eg, rhinovirus, influenza, parainfluenza). A small percentage develop secondary bacterial infection with streptococci, pneumococci, Haemophilus influenzae, Moraxella catarrhalis, or staphylococci. […] In an upper respiratory infection (URI), the swollen nasal mucous membrane obstructs the ostium of a paranasal sinus, and the oxygen in the sinus is absorbed into the blood vessels of the mucous membrane. The resulting relative negative pressure in the sinus (vacuum sinusitis) is painful. If the vacuum is maintained, a transudate from the mucous membrane develops and fills the sinus; the transudate serves as a medium for bacteria that enter the sinus through the ostium or through a spreading cellulitis or thrombophlebitis in the lamina propria of the mucous membrane. An outpouring of serum and leukocytes to combat the infection results, and painful positive pressure develops in the obstructed sinus. The mucous membrane becomes hyperemic and edematous. […] Most acute sinusitis in immunocompetent patients is viral.

• #2 Sinusitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000647.htm

  Sinusitis is present when the tissue lining the sinuses become swollen or inflamed. It occurs as the result of an inflammatory reaction or an infection from a virus, bacteria, or fungus. […] When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily. […] Acute sinusitis is when symptoms are present for 4 weeks or less. It is caused by viruses or bacteria growing in the sinuses. […] Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away.

• #2 Rhinosinusitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinosinusitis_pathophysiology

  The pathophysiology for both acute and chronic rhinosinusitis involves blockage of the nasal sinuses and inflammation of the nasal sinuses. However, biofilms play a role in the pathogenesis of chronic rhinosinusitis. […] Pathophysiology of acute rhinosinusitis could be explained by several mechanisms: Anatomic variants: Since imaging modalities are not necessary for uncomplicated ARS, there aren’t enough evident regarding the contribution of anatomy to the pathogenesis of ARS. However, several contributing factors have been proposed: Anomalies of the unicate and middle turbinate, Stenosis of the infundibulum, Recirculation phenomenon, Infraorbital ethmoid cells, Nasoseptal deviation. […] Allergy: Allergens trigger the recruitment of eosinophils into the maxillary sinus causing inflammation.

• #2 Sinus Infection | Causes, Symptoms & Treatment | ACAAI Public Website

  https://acaai.org/allergies/allergic-conditions/sinus-infection/

  Sinusitis is an inflammation of the sinuses. It is often caused by bacterial (germ) infection. Sometimes, viruses and fungi (molds) cause it. People with weak immune systems are more likely to develop bacterial or fungal sinus infection. […] A sinus infection stops the normal flow of mucus from the sinuses to the back of the throat. The tiny hair-like “sweepers” become blocked when infections or allergies cause tiny nasal tissues to swell. The swelling traps mucus in the sinuses. […] Sinus infections happen when you “catch a bug” and a virus, bacteria or mold settles in the sinuses and causes inflammation of the area lining your sinuses. The sinus cavity, which is like a dark cave, fills up with fluid and becomes blocked. This is the perfect place for germs to grow. People who have nasal allergies already have this sinus irritation. If you have a weak immune system, you are more likely to develop sinus infection from bacteria or mold. Other things that can cause sinus infections are colds, seasonal allergies, nasal polyps or a deviated septum. With a deviated septum one side of the nose is shifted over, and it makes it hard to drain mucous, so the sinuses get backed up.

• #2 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  A number of factors can contribute to the development of sinusitis. The most common cause of acute bacterial sinusitis is a viral upper respiratory infection. Up to 0.5 percent of upper respiratory infections in adults develop into documented sinusitis. Children experience six to eight colds per year, and approximately 5 to 10 percent of these infections are complicated by sinusitis. Allergic rhinitis has also been considered a contributing factor to sinusitis; however, no causal relationship has been proved, and it is now believed to be a rare initiating factor. Iatrogenic factors include mechanical ventilation, nasogastric tubes, nasal packing and dental procedures. Pregnancy, hormone changes associated with puberty, and senile rhinorrhea may be contributing factors. Anatomic variations include tonsillar and adenoid hypertrophy, deviated septum, nasal polyps and cleft palate.

• #2 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Viruses are the most common cause of acute rhinosinusitis. The viral rhinosinusitis (VRS) pathogens include rhinovirus, adenovirus, influenza virus, and parainfluenza virus. The most common causes of acute bacterial rhinosinusitis (ABRS) are Streptococcus pneumoniae (38%), Haemophilus influenzae (36%), and Moraxella catarrhalis (16%). […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis.

• #2

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  If the acute sinusitis does not resolve, chronic sinusitis can develop from mucus retention, hypoxia, and blockade of the ostia. This promotes mucosal hyperplasia, continued recruitment of inflammatory infiltrates, and the potential development of nasal polyps. […] When bacterial growth occurs in acute sinusitis, the most common organisms include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. […] A distinct entity, allergic fungal sinusitis (AFS), occurs in immunocompetent patients and results from an immunologic reaction to fungi that colonize the sinuses. […] This is an allergic noninvasive response to the fungus that should be distinguished from invasive fungal sinusitis, which is more common in diabetic and immunocompromised patients.

• #2 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Acute bacterial rhinosinusitis is most commonly viral. The large majority of cases will either resolve spontaneously or can be effectively treated with antibiotics. Invasive fungal rhinosinusitis is a rare, serious form of the infection that can occur in immunocompromised patients. It is associated with a high morbidity and mortality rate. […] Complications are rare, occurring in about 1 out of every 1000 cases. Sinus infections may spread to the orbit, bone, or intracranial cavities. Eighty percent of orbitocranial complications occur in the orbit. These complications can come with significant morbidity and mortality.

• #2 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  Acute sinusitis typically develops from a viral or bacterial infection of the paranasal sinuses leading to inflammation, edema, and ultimately obstruction of the sinus outflow tracts. […] Intracranial complications of sinusitis occur more commonly in children and are classically associated with adolescent males with spread of frontal sinus disease through the veins of Breschet which communicate directly with the dura. However, disease can also spread intracranially from other sites such as the ethmoid or sphenoid sinuses. Extension of the disease intracranially can lead to meningitis, superior sagittal sinus thrombosis, epidural abscess, subdural empyema or abscess, cerebral abscess, or frontal bone osteomyelitis (i.e., Potts puffy tumor). […] Imaging, most commonly CT with contrast, is indicated although MRI with and without contrast better differentiates subdural empyema or intracranial abscess from adjacent cerebritis and inflammation. Sampling from an involved sinus with endoscopic visualization or trephination (preferable in some cases of isolated frontal sinusitis in order to not disturb the mucosa of the outflow tract or when the degree of infection/inflammation makes endoscopic visualization challenging) can be helpful for identification and susceptibility of the responsible pathogen. ESS may also allow for better source control of the disease.

• #3 Acute Rhinosinusitis – Causes – Investigations – Management – TeachMeSurgery

  https://teachmesurgery.com/ent/nose/acute-rhinosinusitis/

  Acute rhinosinusitis is a common condition, affecting 8-15% of the population at any one time. It is characterised by acute inflammation of the mucosal linings of the nasal passage (rhinitis) and paranasal sinuses (sinusitis). […] There are a variety of precipitants for acute inflammation of nasal mucosa, such as infection and allergy. Inflammation of mucosa results in blockage of the paranasal sinuses and subsequently can lead to a bacterial infection. […] The most common causes are a viral organisms, such as rhinovirus, influenza, or adenovirus, however can also be caused by bacterial organisms, such as S. pneumoniae, H. Influenzae, or M. catarrhalis. […] Acute rhinosinusitis is inflammation of the mucosal linings of the nasal passage and paranasal sinuses.

• #3 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  The sinuses are normally sterile under physiologic conditions. Purulent sinusitis can occur when ciliary clearance of sinus secretions decreases or when the sinus ostium becomes obstructed, which leads to retention of secretions, negative sinus pressure, and reduction of oxygen partial pressure. This environment is then suitable for growth of pathogenic organisms. Factors that predispose the sinuses to obstruction and decreased ciliary function are allergic, nonallergic, or viral insults, which produce inflammation of the nasal and sinus mucosa and result in ciliary dysmotility and sinus obstruction. Approximately 90% of patients who have viral upper respiratory tract infections (URTIs) have sinus involvement, but only 5-10% of these patients have bacterial superinfection requiring antimicrobial treatment.

• #3

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  If the acute sinusitis does not resolve, chronic sinusitis can develop from mucus retention, hypoxia, and blockade of the ostia. This promotes mucosal hyperplasia, continued recruitment of inflammatory infiltrates, and the potential development of nasal polyps. […] When bacterial growth occurs in acute sinusitis, the most common organisms include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. […] A distinct entity, allergic fungal sinusitis (AFS), occurs in immunocompetent patients and results from an immunologic reaction to fungi that colonize the sinuses. […] This is an allergic noninvasive response to the fungus that should be distinguished from invasive fungal sinusitis, which is more common in diabetic and immunocompromised patients.

• #3 Pulsenotes | Acute rhinosinusitis

  https://app.pulsenotes.com/surgery/ent/notes/acute-rhinosinusitis

  Acute rhinosinusitis is most commonly due to an upper respiratory tract viral pathogen. […] Acute rhinosinuitis is most commonly caused by viruses, although a small percentage (0.5-2%) are due to bacterial infections. […] Direct contact between an infective viral pathogen and the nasal or conjunctival mucosa can lead to viral replication and symptoms within the first day of inoculation. It is suspected that nose blowing then prompts propagation of the infection to the paranasal sinuses. As the infection develops it leads to excess sinonasal secretions, increased vascular permeability and mucosal oedema. […] Bacterial rhinosinusitis usually occurs as a secondary infection in an already inflamed sinus cavity. Thus, it can be thought about as one of the complications of viral rhinosinusitis. It can also occur secondary to any condition that effects drainage of the sinonasal passages (e.g. foreign body, cystic fibrosis) or impaired local immune responses (e.g. dental abscess). […] Complicated rhinosinusitis refers to extension of the infection beyond the nasal cavities and paranasal sinuses. This extension can lead to significant complications that require urgent hospital admission for treatment.

• #3 Management Of Acute Rhinosinusitis In Pediatric Patients

  https://www.ebmedicine.net/topics/respiratory/pediatric-acute-rhinosinusitis

  Rhinosinusitis may be due to 3 pathological causes: […] Obstruction of sinus drainage pathways (sinus ostia) […] Ciliary impairment […] Altered mucus quantity and quality. […] Blockage or inflammation at the OMC is responsible for the development of viral and subsequently bacterial sinusitis, as it interferes with effective mucociliary clearance. […] Blockage of the sinus ostium is the main predisposing factor for suppurative infection, and it often results from URIs or other viral infections that are common in early childhood. […] The drainage patterns of the paranasal sinuses depend on the mucociliary transport mechanism. The ciliated columnar epithelial cells propel the sinus contents toward the natural sinus ostia, and disruption of their function results in fluid accumulation inside the sinus cavity. […] Defective ciliary function may result from the loss of ciliated epithelial cells; enhanced airflow; viral, bacterial, or environmental ciliotoxins; inflammatory mediators; scars; and Kartagener syndrome.

• #3 Recent Advances in Understanding the Pathophysiology of Rhinosinusitis | Ento Key

  https://entokey.com/recent-advances-in-understanding-the-pathophysiology-of-rhinosinusitis/

  Rhinosinusitis is a disease with a multifactorial etiology and hence diverse phenotypes. […] Several endogenous factors, such as anatomical abnormalities, humoral and cellular immune disorders, including allergy, hormonal factors, and acquired or congenital disturbances of the mucociliary clearance, have all been associated with the development and/or chronicity of rhinosinusitis. […] In addition, external factors, such as microbial agents causing infection and/or colonization, and iatrogenic factors may underlie the development of rhinosinusitis. […] Symptomatic inflammation of the sinonasal mucosa is the diagnostic criterion for defining rhinosinusitis. […] Normal mucociliary flow is a significant defense mechanism in the prevention of ARS. […] The impaired mucociliary function during viral rhinosinusitis results in an increased sensitivity to bacterial infection.

• #3 Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/1115/p1795.html

  Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. […] Failure of normal mucus transport and decreased sinus ventilation are the major factors contributing to the development of sinusitis. Obstruction of the sinus ostia occurs with mucosal edema or any anatomic abnormality that interferes with drainage. Bacterial and viral infections also impair the mucus transport system. The frequency of ciliary beats (normally 700 per minute) decreases to less than 300 per minute during periods of infection. Inflammation causes 30 percent of the ciliated columnar cells to undergo metaplastic changes to mucus-secreting goblet cells. The obstruction and decreased transport results in stagnation of secretions, decreased pH and lowered oxygen tension within the sinus, creating an excellent culture medium for bacteria.

• #3 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  In rhinosinusitis, altered sinus secretions exacerbate the susceptibility to persistent infection and subsequent inflammation. Normally, the mucous blanket in the respiratory tract consists of 2 distinct layers: the periciliary liquid phase, a thin, low-viscosity layer surrounding the cilia shaft allowing free ciliary movement, and the gel phase, a more viscous layer atop the periciliary liquid. In the presence of inflammation, derangements in the mucous layer separation can impair ciliary movement by disrupting the usual low-viscosity environment. […] Additionally, bacterial biofilms contribute to sinusitis pathogenesis, although they are more prevalent in chronic cases rather than in RARS. Biofilms hinder antibiotic penetration because bacteria within this layer are not only attached firmly to one another as well as their substrate but they are also surrounded by a protective proteinaceous or polysaccharide matrix. S aureus, notably, is adept at producing biofilms, which often require chemical and possibly mechanical disruption for definitive infection clearance.

• #3 Sinusitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

  Acute sinusitis in immunocompetent patients in the community is almost always viral (eg, rhinovirus, influenza, parainfluenza). A small percentage develop secondary bacterial infection with streptococci, pneumococci, Haemophilus influenzae, Moraxella catarrhalis, or staphylococci. […] In an upper respiratory infection (URI), the swollen nasal mucous membrane obstructs the ostium of a paranasal sinus, and the oxygen in the sinus is absorbed into the blood vessels of the mucous membrane. The resulting relative negative pressure in the sinus (vacuum sinusitis) is painful. If the vacuum is maintained, a transudate from the mucous membrane develops and fills the sinus; the transudate serves as a medium for bacteria that enter the sinus through the ostium or through a spreading cellulitis or thrombophlebitis in the lamina propria of the mucous membrane. An outpouring of serum and leukocytes to combat the infection results, and painful positive pressure develops in the obstructed sinus. The mucous membrane becomes hyperemic and edematous. […] Most acute sinusitis in immunocompetent patients is viral.

• #3 Management Of Acute Rhinosinusitis In Pediatric Patients

  https://www.ebmedicine.net/topics/respiratory/pediatric-acute-rhinosinusitis

  The sinonasal secretions play a major role in the pathophysiology of rhinosinusitis. The mucus blanket that lines the paranasal sinuses contains immunoglobulins, mucoglycoproteins, and inflammatory cells. […] An increase in the mucosal viscosity, as in cystic fibrosis, slows the transport toward the ostia and the gel layer thickens, causing retention of thick mucus inside the sinus. […] The mechanism by which viruses predispose to bacterial sinusitis may involve viral-bacterial synergy, induction of local inflammation that blocks the sinus ostia, increase of bacterial attachment to the epithelial cells, and disruption of the local immune defense. […] Conditions that promote the growth of anaerobic bacteria include reduction in oxygen tension and an increase in acidity within the sinus.

• #3 Acute rhinosinusitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-sinusitis?lang=us

  Acute rhinosinusitis usually occurs following a viral upper respiratory tract infection. Dental caries, periapical abscess and oroantral fistulation may lead to a spread of infection to the maxillary sinus. Cystic fibrosis and allergy are risk factors. […] Other anatomical variants that may predispose to the inflammation include nasal septal deviation, a spur of the nasal septum and/or frontoethmoidal recess variants. […] Rhinitis, often associated with sinusitis, is often characterized by thickening of the turbinates with obliteration of the surrounding air channels. This should not be confused with the normal nasal cycle ref. […] The fat pads surrounding the sinuses should be assessed for extra-sinus extension of disease ref, e.g. the retromaxillary fat posterior to the maxillary sinus. […] The maxillary dentition should also be assessed as ~20% of maxillary sinus infections are odontogenic 11.

• #3 Sinusitis-Acute and Chronic – Brigham and Women’s Faulkner Hospital

  https://www.brighamandwomensfaulkner.org/programs-and-services/otolaryngology/nose-conditions/sinusitis-acute-and-chronic

  A sinus infection often follows an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can lead to obstruction of the opening of the paranasal sinuses, which can lead to infection in the sinuses. […] Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus.

• #3 Characteristics of Sinusitis in the Era of COVID-19 | JAA

  https://www.dovepress.com/epidemiological-characteristics-pathogenesis-and-clinical-implications-peer-reviewed-fulltext-article-JAA

  Evidence shows that chronic rhinosinusitis is significantly associated with increasing the risk of sepsis, pneumonia, and mortality. This might be attributed to the fact that the presence of sinusitis might lead to a significant reduction in nitric oxide production and can provide a viral or bacterial reservoir, increasing the susceptibility to developing a secondary infection and reducing the functions of the host immune response. […] Different mechanisms and pathogenetic theories have been proposed to justify the association between severe COVID-19 or increased infectivity of SARS-CoV-2 and chronic rhinosinusitis. For instance, chronic rhinosinusitis is usually caused by a viral infection, which increases the risk of other viral co-infections, including SAR-CoV-2. […] Moreover, it has been shown that the rate of coronavirus infection was 21.6% in these patients.

• #3 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  Anatomical variations that narrow the ostiomeatal complex, including septal deviation, paradoxical middle turbinates, and Haller cells, make this area more sensitive to obstruction from mucosal inflammation. Mechanical obstruction of the ostiomeatal complex from foreign bodies, polyps, or tumors can also result in acute sinus disease. Systemic diseases that result in decreased mucociliary clearance, including cystic fibrosis and Kartagener syndrome, can be predisposing factors for acute sinusitis in rare cases. Patients with immunodeficiencies (eg, agammaglobulinemia, combined variable immunodeficiency, and immunodeficiency with reduced immunoglobulin G [IgG] and immunoglobulin A [IgA]bearing cells) are also at increased risk of developing acute sinusitis. […] Ciliary function is also reduced in the presence of low pH, anoxia, bacterial toxins, smoking, dehydration, foreign bodies, and drugs (eg, atropine, antihistamines, phenylephedrine). Approximately 10% of cases of acute sinusitis result from direct inoculation of the sinus with a large amount of bacteria. Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Facial trauma or large inoculations from swimming can produce sinusitis as well.

• #3 Acute Rhinosinusitis in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1057.html

  Most cases of acute rhinosinusitis are caused by viral infections associated with the common cold. Mucosal edema leads to obstruction of the sinus ostia. In addition, viral and bacterial infections impair the cilia, which transport mucus. The obstruction and slowed mucus transport cause stagnation of secretions and lowered oxygen tension within the sinuses. This environment is an excellent culture medium for viruses and bacteria. The most common bacterial organisms in community-acquired acute bacterial rhinosinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis. The most common viruses in acute viral rhinosinusitis are rhinovirus, adenovirus, influenza virus, and parainfluenza virus. […] Diagnosis of acute bacterial rhinosinusitis requires that symptoms persist for longer than 10 days or worsen after five to seven days.

• #3 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute sinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis. When this occurs, bacteria can remain in, gain access to, and proliferate within the usually sterile paranasal sinuses. Severe complications can occur when the sinus infection spreads to surrounding structures, such as the brain and orbit, via the valve-less diploic veins. These are veins located within the inner cancellous bone layer of the skull. This is thankfully a rare phenomenon, but important to remember. […]

• #3 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Acute bacterial rhinosinusitis is most commonly viral. The large majority of cases will either resolve spontaneously or can be effectively treated with antibiotics. Invasive fungal rhinosinusitis is a rare, serious form of the infection that can occur in immunocompromised patients. It is associated with a high morbidity and mortality rate. […] Complications are rare, occurring in about 1 out of every 1000 cases. Sinus infections may spread to the orbit, bone, or intracranial cavities. Eighty percent of orbitocranial complications occur in the orbit. These complications can come with significant morbidity and mortality.

• #3 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #4 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute sinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis. When this occurs, bacteria can remain in, gain access to, and proliferate within the usually sterile paranasal sinuses. Severe complications can occur when the sinus infection spreads to surrounding structures, such as the brain and orbit, via the valve-less diploic veins. These are veins located within the inner cancellous bone layer of the skull. This is thankfully a rare phenomenon, but important to remember. […]

• #4 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  Rhinosinusitis, or more commonly sinusitis, is the medical term for inflammation (swelling) of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the nasal openings. The most common cause of acute sinusitis is a viral infection associated with the common cold. This condition is also called viral sinusitis. Bacterial sinusitis occurs much less commonly, in only 0.5 to 2 percent of cases, usually as a complication of viral sinusitis. Because antibiotics are effective only against bacterial, and not viral, infections, most people with acute sinusitis do not need antibiotics and would be putting themselves at risk for medication side effects and for developing antibiotic resistance by taking them for nonbacterial sinusitis. Most adults with normal immune systems can also clear bacterial infections without antibiotics.

• #4 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  The sinuses are normally sterile under physiologic conditions. Purulent sinusitis can occur when ciliary clearance of sinus secretions decreases or when the sinus ostium becomes obstructed, which leads to retention of secretions, negative sinus pressure, and reduction of oxygen partial pressure. This environment is then suitable for growth of pathogenic organisms. Factors that predispose the sinuses to obstruction and decreased ciliary function are allergic, nonallergic, or viral insults, which produce inflammation of the nasal and sinus mucosa and result in ciliary dysmotility and sinus obstruction. Approximately 90% of patients who have viral upper respiratory tract infections (URTIs) have sinus involvement, but only 5-10% of these patients have bacterial superinfection requiring antimicrobial treatment.

• #4

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/

  The most common cause of acute sinusitis is an upper respiratory tract infection (URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that usually resolves without treatment in less than 14 days. If symptoms worsen after 3 to 5 days or persist for longer than 10 days and are more severe than normally experienced with a viral infection, a secondary bacterial infection is diagnosed. The inflammation can predispose to the development of acute sinusitis by causing sinus ostial blockage. […] The nasal mucosa responds to the virus by producing mucus and recruiting mediators of inflammation, such as white blood cells, to the lining of the nose, which cause congestion and swelling of the nasal passages. The resultant sinus cavity hypoxia and mucus retention cause the cilia which move mucus and debris from the nose to function less efficiently, creating an environment for bacterial growth.

• #4 Recent Advances in Understanding the Pathophysiology of Rhinosinusitis | Ento Key

  https://entokey.com/recent-advances-in-understanding-the-pathophysiology-of-rhinosinusitis/

  Superinfection of bacteria on mucosa damaged by viral infection during a virally induced common cold is considered to be the most important cause of ARS. […] The most frequent bacterial species isolated from the maxillary sinuses of patients with ARS are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the latter being more common in children. […] Ciliary function plays an important role in the clearance of sinuses and the prevention of chronic inflammation. […] Malfunction of the ciliary clearance may be a congenital or acquired condition.

• #4 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Healthy sinuses are composed of ciliated pseudostratified columnar epithelium, which uses cilia to clear the sinuses of debris, mucus, and other substances. The mucosal edema, infiltration of granulocytes and lymphocytes, squamous metaplasia, and fibroblast proliferation from acute rhinosinusitis disrupts this process. […] […] Acute bacterial rhinosinusitis is most commonly viral. The large majority of cases will either resolve spontaneously or can be effectively treated with antibiotics. Invasive fungal rhinosinusitis is a rare, serious form of the infection that can occur in immunocompromised patients. It is associated with a high morbidity and mortality rate.

• #4 Management Of Acute Rhinosinusitis In Pediatric Patients

  https://www.ebmedicine.net/topics/respiratory/pediatric-acute-rhinosinusitis

  The sinonasal secretions play a major role in the pathophysiology of rhinosinusitis. The mucus blanket that lines the paranasal sinuses contains immunoglobulins, mucoglycoproteins, and inflammatory cells. […] An increase in the mucosal viscosity, as in cystic fibrosis, slows the transport toward the ostia and the gel layer thickens, causing retention of thick mucus inside the sinus. […] The mechanism by which viruses predispose to bacterial sinusitis may involve viral-bacterial synergy, induction of local inflammation that blocks the sinus ostia, increase of bacterial attachment to the epithelial cells, and disruption of the local immune defense. […] Conditions that promote the growth of anaerobic bacteria include reduction in oxygen tension and an increase in acidity within the sinus.

• #4 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #4 Acute and Subacute Sinusitis | Radiology Key

  https://radiologykey.com/acute-and-subacute-sinusitis/

  Sinusitis is an inflammation of the paranasal sinus mucoperiosteal lining. […] Rhinosinusitis is acute when symptoms last 3 weeks. […] The vast majority of rhinosinusitis episodes are caused by viruses. […] Disruption of the ciliary function results in accumulation of sinus secretions and potentially infectious agents within the sinus. […] When the natural sinus ostia become obstructed, normal mucus drainage is impeded. […] The obstructed sinus environment becomes hypoxic and causes ciliary dysfunction and changes in mucus production all of this further reducing normal mucus clearance. […] Uncomplicated acute bacterial sinusitis should be considered akin to an abscess or empyema since it is essentially a collection of pus under pressure. […] It is this fundamental situation that creates a potential for the orbital and intracranial complications. […] Relieving this pressure by draining the causative sinus is a strategy aimed at the prevention and treatment of such complications.

• #4 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  Anatomical variations that narrow the ostiomeatal complex, including septal deviation, paradoxical middle turbinates, and Haller cells, make this area more sensitive to obstruction from mucosal inflammation. Mechanical obstruction of the ostiomeatal complex from foreign bodies, polyps, or tumors can also result in acute sinus disease. Systemic diseases that result in decreased mucociliary clearance, including cystic fibrosis and Kartagener syndrome, can be predisposing factors for acute sinusitis in rare cases. Patients with immunodeficiencies (eg, agammaglobulinemia, combined variable immunodeficiency, and immunodeficiency with reduced immunoglobulin G [IgG] and immunoglobulin A [IgA]bearing cells) are also at increased risk of developing acute sinusitis. […] Ciliary function is also reduced in the presence of low pH, anoxia, bacterial toxins, smoking, dehydration, foreign bodies, and drugs (eg, atropine, antihistamines, phenylephedrine). Approximately 10% of cases of acute sinusitis result from direct inoculation of the sinus with a large amount of bacteria. Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Facial trauma or large inoculations from swimming can produce sinusitis as well.

• #4 Rhinosinusitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinosinusitis_pathophysiology

  Viruses: Viruses (e.g. Rhinovirus, H1N1), inhibit the mucociliary clearance and local swelling which in turn leads to the blockade of the sinus ostea and subsequent bacterial infection. […] Odontogenic infection: The proximity of maxillary sinus to the teeth roots causes rhinosinusitis in patients with dental maxillary pathology.

• #4 Management Of Acute Bacterial Rhinosinusitis: Current Issues And Future Perspectives

  https://www.medscape.org/viewarticle/537244

  Acute bacterial rhinosinusitis (ABRS), which manifests as an inflammation of at least one of the paranasal sinuses, is a major public health issue in developed countries. […] For acute sinusitis, the inflammation is predominantly caused by viral or bacterial microorganisms, while the inflammation in chronic sinusitis can be due to a number of different causes. […] Medical conditions that adversely affect the normal functioning of epithelial cells, such as viral RTIs, lead to accumulation and stagnation of secretions and bacteria in sinuses. This disturbance of sinus homeostasis creates the conditions for bacterial superinfection leading to acute bacterial rhinosinusitis (ABRS). […] The main causative agents of ABRS are Streptococcus pneumoniae and Haemophilus influenzae, while Moraxella catarrhalis, Staphylococcus pyogenes, Staphylococcus aureus and various anaerobes are less-frequent pathogens.

• #4

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/urisin.htm

  The spores from these fungi are in the soil and air and enter through the mouth and the nose. The spores attach to the nasal or oral mucosa where massive spore germination occurs. Individuals who are immunocompetent produce phagocytes that will phagocytize these spores and they do not develop the disease. In immunocompromised patients their phagocytes aren’t able to phagocytize the spores quick enough. This allows the spores the time they need to germinate and form hyphae. The hyphae then get into the blood vessels. The hyphae invade the nasal cavity and maxillary sinuses. Rhizopus organisms have an enzyme, ketone reductase, which allows them to thrive in high glucose, acidic conditions. Serum from patients with diabetic ketoacidosis stimulates growth.

• #4 Sinusitis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/sinusitis/

  Most important pathophysiological change: obstruction of sinus drainage. […] Normal metachronous movement of mucous toward the natural ostia of the sinuses is usually disrupted by mucosal inflammation stasis. […] Ciliary function impairment leads to a reduction in mucus drainage stasis. […] Stasis of secretions inside the sinuses leads to a proliferation of microorganisms. […] Alterations in the composition and quantity of mucus can also contribute to infection; increased mucus production is seen with asthma, rhinitis, and viral URIs.

• #5 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Viruses are the most common cause of acute rhinosinusitis. The viral rhinosinusitis (VRS) pathogens include rhinovirus, adenovirus, influenza virus, and parainfluenza virus. The most common causes of acute bacterial rhinosinusitis (ABRS) are Streptococcus pneumoniae (38%), Haemophilus influenzae (36%), and Moraxella catarrhalis (16%). […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis.

• #5 Acute Rhinosinusitis in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1057.html

  Most cases of acute rhinosinusitis are caused by viral infections associated with the common cold. Mucosal edema leads to obstruction of the sinus ostia. In addition, viral and bacterial infections impair the cilia, which transport mucus. The obstruction and slowed mucus transport cause stagnation of secretions and lowered oxygen tension within the sinuses. This environment is an excellent culture medium for viruses and bacteria. The most common bacterial organisms in community-acquired acute bacterial rhinosinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis. The most common viruses in acute viral rhinosinusitis are rhinovirus, adenovirus, influenza virus, and parainfluenza virus. […] Diagnosis of acute bacterial rhinosinusitis requires that symptoms persist for longer than 10 days or worsen after five to seven days.

• #5 Pulsenotes | Acute rhinosinusitis

  https://app.pulsenotes.com/surgery/ent/notes/acute-rhinosinusitis

  Acute rhinosinusitis is most commonly due to an upper respiratory tract viral pathogen. […] Acute rhinosinuitis is most commonly caused by viruses, although a small percentage (0.5-2%) are due to bacterial infections. […] Direct contact between an infective viral pathogen and the nasal or conjunctival mucosa can lead to viral replication and symptoms within the first day of inoculation. It is suspected that nose blowing then prompts propagation of the infection to the paranasal sinuses. As the infection develops it leads to excess sinonasal secretions, increased vascular permeability and mucosal oedema. […] Bacterial rhinosinusitis usually occurs as a secondary infection in an already inflamed sinus cavity. Thus, it can be thought about as one of the complications of viral rhinosinusitis. It can also occur secondary to any condition that effects drainage of the sinonasal passages (e.g. foreign body, cystic fibrosis) or impaired local immune responses (e.g. dental abscess). […] Complicated rhinosinusitis refers to extension of the infection beyond the nasal cavities and paranasal sinuses. This extension can lead to significant complications that require urgent hospital admission for treatment.

• #5 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  Anatomical variations that narrow the ostiomeatal complex, including septal deviation, paradoxical middle turbinates, and Haller cells, make this area more sensitive to obstruction from mucosal inflammation. Mechanical obstruction of the ostiomeatal complex from foreign bodies, polyps, or tumors can also result in acute sinus disease. Systemic diseases that result in decreased mucociliary clearance, including cystic fibrosis and Kartagener syndrome, can be predisposing factors for acute sinusitis in rare cases. Patients with immunodeficiencies (eg, agammaglobulinemia, combined variable immunodeficiency, and immunodeficiency with reduced immunoglobulin G [IgG] and immunoglobulin A [IgA]bearing cells) are also at increased risk of developing acute sinusitis. […] Ciliary function is also reduced in the presence of low pH, anoxia, bacterial toxins, smoking, dehydration, foreign bodies, and drugs (eg, atropine, antihistamines, phenylephedrine). Approximately 10% of cases of acute sinusitis result from direct inoculation of the sinus with a large amount of bacteria. Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Facial trauma or large inoculations from swimming can produce sinusitis as well.

• #5 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Healthy sinuses are composed of ciliated pseudostratified columnar epithelium, which uses cilia to clear the sinuses of debris, mucus, and other substances. The mucosal edema, infiltration of granulocytes and lymphocytes, squamous metaplasia, and fibroblast proliferation from acute rhinosinusitis disrupts this process. […] Acute rhinosinusitis is a clinical diagnosis. Three cardinal symptoms that are most sensitive and specific for acute rhinosinusitis are purulent nasal drainage accompanied by either nasal obstruction or facial pain/pressure/fullness. […] Severe symptoms are more indicative of a bacterial cause. These include high fevers (over 39 C or 102 F) accompanied by purulent nasal discharge or facial pain for three to four consecutive days at the beginning of the illness. […] The culture of endoscopic aspirates with greater than or equal to 10 CFU/mL is considered the gold standard. However, this is not necessary for diagnosis and not done for the vast majority of cases of ABRS.

• #5 Management Of Acute Rhinosinusitis In Pediatric Patients

  https://www.ebmedicine.net/topics/respiratory/pediatric-acute-rhinosinusitis

  The sinonasal secretions play a major role in the pathophysiology of rhinosinusitis. The mucus blanket that lines the paranasal sinuses contains immunoglobulins, mucoglycoproteins, and inflammatory cells. […] An increase in the mucosal viscosity, as in cystic fibrosis, slows the transport toward the ostia and the gel layer thickens, causing retention of thick mucus inside the sinus. […] The mechanism by which viruses predispose to bacterial sinusitis may involve viral-bacterial synergy, induction of local inflammation that blocks the sinus ostia, increase of bacterial attachment to the epithelial cells, and disruption of the local immune defense. […] Conditions that promote the growth of anaerobic bacteria include reduction in oxygen tension and an increase in acidity within the sinus.

• #5 Acute and Subacute Sinusitis | Radiology Key

  https://radiologykey.com/acute-and-subacute-sinusitis/

  Sinusitis is an inflammation of the paranasal sinus mucoperiosteal lining. […] Rhinosinusitis is acute when symptoms last 3 weeks. […] The vast majority of rhinosinusitis episodes are caused by viruses. […] Disruption of the ciliary function results in accumulation of sinus secretions and potentially infectious agents within the sinus. […] When the natural sinus ostia become obstructed, normal mucus drainage is impeded. […] The obstructed sinus environment becomes hypoxic and causes ciliary dysfunction and changes in mucus production all of this further reducing normal mucus clearance. […] Uncomplicated acute bacterial sinusitis should be considered akin to an abscess or empyema since it is essentially a collection of pus under pressure. […] It is this fundamental situation that creates a potential for the orbital and intracranial complications. […] Relieving this pressure by draining the causative sinus is a strategy aimed at the prevention and treatment of such complications.

• #5 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #5 Acute rhinosinusitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-sinusitis?lang=us

  Acute rhinosinusitis usually occurs following a viral upper respiratory tract infection. Dental caries, periapical abscess and oroantral fistulation may lead to a spread of infection to the maxillary sinus. Cystic fibrosis and allergy are risk factors. […] Other anatomical variants that may predispose to the inflammation include nasal septal deviation, a spur of the nasal septum and/or frontoethmoidal recess variants. […] Rhinitis, often associated with sinusitis, is often characterized by thickening of the turbinates with obliteration of the surrounding air channels. This should not be confused with the normal nasal cycle ref. […] The fat pads surrounding the sinuses should be assessed for extra-sinus extension of disease ref, e.g. the retromaxillary fat posterior to the maxillary sinus. […] The maxillary dentition should also be assessed as ~20% of maxillary sinus infections are odontogenic 11.

• #5 Acute Sinusitis: Causes, Symptoms & Diagnosis

  https://www.healthline.com/health/acute-sinusitis

  Acute sinusitis, also called acute rhinosinusitis, is a short-term inflammation of the membranes that line your nose and surrounding sinuses. This impedes your ability to drain mucus from your nose and sinuses. […] As a common health issue affecting 1 in 8 adults each year, acute sinusitis is most often caused by a cold or viral infection. But it can also be due to noninfectious causes, including seasonal allergies, nasal issues, or health conditions like cystic fibrosis. […] Illnesses and conditions that can cause or lead to acute sinusitis include: viruses, bacteria, fungi, intranasal allergies, such as hay fever, nasal polyps or other tumors, deviated nasal septum, infected adenoids, cystic fibrosis, an inherited genetic disease where thick, sticky mucus builds up in the body. […] An infected tooth could also cause acute sinusitis, as bacteria can spread from the infected tooth to the sinuses.

• #5 Management Of Acute Rhinosinusitis In Pediatric Patients

  https://www.ebmedicine.net/topics/respiratory/pediatric-acute-rhinosinusitis

  The microbiology of ABRS in children can be extrapolated from studies of middle ear fluid of children with acute otitis media in the postpneumococcal vaccine era. […] The predominant respiratory pathogens were S pneumoniae, nontypeable H influenzae, and M catarrhalis; however, the proportion of H influenzae in relation to S pneumoniae has increased in recent years, and it has become the predominant isolate. […] The origin of the pathogens introduced into the sinuses that eventually cause rhinosinusitis is, primarily, the nasal cavity. The normal flora of the nasal cavity contain certain bacterial species and include S aureus, Staphylococcus epidermidis, alpha- and gamma-streptococci, Propionibacterium acnes, and facultative diphtheroids. […] Potential sinus pathogens are rarely found in the healthy nasal cavity.

• #5

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/urisin.htm

  The spores from these fungi are in the soil and air and enter through the mouth and the nose. The spores attach to the nasal or oral mucosa where massive spore germination occurs. Individuals who are immunocompetent produce phagocytes that will phagocytize these spores and they do not develop the disease. In immunocompromised patients their phagocytes aren’t able to phagocytize the spores quick enough. This allows the spores the time they need to germinate and form hyphae. The hyphae then get into the blood vessels. The hyphae invade the nasal cavity and maxillary sinuses. Rhizopus organisms have an enzyme, ketone reductase, which allows them to thrive in high glucose, acidic conditions. Serum from patients with diabetic ketoacidosis stimulates growth.

• #6 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute sinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis. When this occurs, bacteria can remain in, gain access to, and proliferate within the usually sterile paranasal sinuses. Severe complications can occur when the sinus infection spreads to surrounding structures, such as the brain and orbit, via the valve-less diploic veins. These are veins located within the inner cancellous bone layer of the skull. This is thankfully a rare phenomenon, but important to remember. […]

• #6 Rhinosinusitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinosinusitis_pathophysiology

  Viruses: Viruses (e.g. Rhinovirus, H1N1), inhibit the mucociliary clearance and local swelling which in turn leads to the blockade of the sinus ostea and subsequent bacterial infection. […] Odontogenic infection: The proximity of maxillary sinus to the teeth roots causes rhinosinusitis in patients with dental maxillary pathology.

• #6 Recurrent Acute Rhinosinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35995

  The pathogenesis of rhinosinusitis likely involves a combination of viscous sinus secretions and dysfunction of the sinus ostia and ciliary apparatus. Viral upper respiratory infections and allergens cause mucosal edema, narrowing the sinus ostia and causing direct mechanical obstruction. Obstruction of the sinus may lead to the accumulation of secretions, providing an environment conducive to bacterial and fungal growth. Outflow blockage may also cause pressure changes within the sinus as oxygen is resorbed by the mucosa, resulting in a partial vacuum. This negative pressure can be painful and result in the transudation of more fluid into the sinus. The excess fluid, combined with inflammation and the influx of neutrophils and lymphocytes, can ultimately create excessive positive pressure, causing discomfort for patients.

• #7 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Healthy sinuses are composed of ciliated pseudostratified columnar epithelium, which uses cilia to clear the sinuses of debris, mucus, and other substances. The mucosal edema, infiltration of granulocytes and lymphocytes, squamous metaplasia, and fibroblast proliferation from acute rhinosinusitis disrupts this process. […] […] Acute bacterial rhinosinusitis is most commonly viral. The large majority of cases will either resolve spontaneously or can be effectively treated with antibiotics. Invasive fungal rhinosinusitis is a rare, serious form of the infection that can occur in immunocompromised patients. It is associated with a high morbidity and mortality rate.

• #7 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  Rhinosinusitis, or more commonly sinusitis, is the medical term for inflammation (swelling) of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the nasal openings. The most common cause of acute sinusitis is a viral infection associated with the common cold. This condition is also called viral sinusitis. Bacterial sinusitis occurs much less commonly, in only 0.5 to 2 percent of cases, usually as a complication of viral sinusitis. Because antibiotics are effective only against bacterial, and not viral, infections, most people with acute sinusitis do not need antibiotics and would be putting themselves at risk for medication side effects and for developing antibiotic resistance by taking them for nonbacterial sinusitis. Most adults with normal immune systems can also clear bacterial infections without antibiotics.

• #8 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Acute sinusitis is an inflammation of the sinuses. Because sinus passages are contiguous with the nasal passages, rhinosinusitis is often a more appropriate term. Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare expenditure annually. It is also a common reason for antibiotic prescriptions in the United States and throughout the world. Due to recent guidelines and concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear treatment algorithms available for such a common diagnosis. […] […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis. When this occurs, bacteria can remain in, gain access to, and proliferate within the usually sterile paranasal sinuses. Severe complications can occur when the sinus infection spreads to surrounding structures, such as the brain and orbit, via the valve-less diploic veins. These are veins located within the inner cancellous bone layer of the skull. This is thankfully a rare phenomenon, but important to remember. […]

• #8 Medical Treatment for Acute Sinusitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/861646-overview

  The sinuses are normally sterile under physiologic conditions. Purulent sinusitis can occur when ciliary clearance of sinus secretions decreases or when the sinus ostium becomes obstructed, which leads to retention of secretions, negative sinus pressure, and reduction of oxygen partial pressure. This environment is then suitable for growth of pathogenic organisms. Factors that predispose the sinuses to obstruction and decreased ciliary function are allergic, nonallergic, or viral insults, which produce inflammation of the nasal and sinus mucosa and result in ciliary dysmotility and sinus obstruction. Approximately 90% of patients who have viral upper respiratory tract infections (URTIs) have sinus involvement, but only 5-10% of these patients have bacterial superinfection requiring antimicrobial treatment.

• #9 Acute Sinusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29065

  Viruses are the most common cause of acute rhinosinusitis. The viral rhinosinusitis (VRS) pathogens include rhinovirus, adenovirus, influenza virus, and parainfluenza virus. The most common causes of acute bacterial rhinosinusitis (ABRS) are Streptococcus pneumoniae (38%), Haemophilus influenzae (36%), and Moraxella catarrhalis (16%). […] Sinuses function to filter out pollutants, microorganisms, dust, and other antigens. Sinuses drain into the intranasal meatus via small channels called ostia. The maxillary, frontal, and anterior ethmoid sinuses drain into the middle meatus, creating a congested area called the osteomeatal complex. The posterior ethmoid and sphenoid sinuses drain into the superior meatus. Tiny hairs called „cilia” line the mucous membranes of the nasal cavity and nasopharynx, and work in an integrated and coordinated fashion to carry out this function of circulating mucus and filtered debris, ultimately leading them to the nasopharynx and oropharynx, where they are swallowed. Rhinosinusitis occurs when the sinuses and nasal passages cannot effectively clear out these antigens, leading to an inflammatory state. This condition usually results from three key factors: obstruction of the sinus ostia (i.e., anatomic causes such as a tumor or septal deviation), dysfunction of the cilia (i.e., Kartagener syndrome), or thickening of sinus secretions (cystic fibrosis). The most common cause of temporary obstruction of these outflow regions is local edema due to upper respiratory tract infections (URI) or nasal allergy, both of which predispose to rhinosinusitis.

• #9 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  The primary treatment for sinusitis involves symptom relief; antibiotic treatment is only necessary for a small percentage of people. You should speak with your health care provider about whether or not you need antibiotic therapy. Bacterial and viral sinusitis will often improve without antibiotic treatment. […] Bacterial sinusitis does not always need to be treated with antibiotics, as many patients improve without antibiotics. You should speak with your health care provider about whether or not you need antibiotics. Patients who have worsening symptoms after being managed with watchful waiting are usually started on antibiotics.

• #10 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Acute sinusitis is the swelling and inflammation of the lining of paranasal sinuses, an air-filled extension of the nasal cavity. It may obstruct fluid drainage leading to the accumulation of mucus within the sinuses. […] Common cold – a viral infection – is the most common cause of acute sinusitis. A bacterial infection may also supervene in some cases. […] Acute sinusitis is most often a consequence of a viral infection, not a bacterial one; therefore, there is no need for antibiotics. Acute sinusitis may resolve without treatment. Before antibiotics prescription, your doctor would observe if your symptoms aggravate. […] Since viral infection causes most cases of acute sinusitis, which usually resolves without specific treatment, antibiotics are not required. Your doctor may consider giving you antibiotics if you have a severe, long-lasting course of sinusitis.

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