Materiały źródłowe

• #1 Acute Sinusitis – StatPearls – NCBI Bookshelf

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

  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.

• #2 Acute Sinusitis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/232670-overview

  Sinusitis is characterized by inflammation of the lining of the paranasal sinuses. Because the nasal mucosa is simultaneously involved and because sinusitis rarely occurs without concurrent rhinitis, rhinosinusitis is the preferred term for this condition. […] The pathophysiology of rhinosinusitis is related to 3 factors: obstruction of sinus drainage pathways (sinus ostia), ciliary impairment, and altered mucus quantity and quality. […] Obstruction of the natural sinus ostia prevents normal mucus drainage. The ostia can be blocked by mucosal swelling or local causes (eg, trauma, rhinitis), as well as by certain inflammation-associated systemic disorders and immune disorders. […] Retained mucus, when infected, leads to sinusitis. Another mechanism hypothesizes that because the sinuses are continuous with the nasal cavity, colonized bacteria in the nasopharynx may contaminate the otherwise sterile sinuses.

• #3

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

  Sinusitis is inflammation of the sinuses, which are air-filled cavities in the skull. The etiology can be infectious (bacterial, viral, or fungal) or noninfectious (allergic) triggers. This inflammation leads to blockade of the normal sinus drainage pathways (sinus ostia), which in turn leads to mucus retention, hypoxia, decreased mucociliary clearance, and predisposition to bacterial growth. […] 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.

• #4 Recurrent Acute Rhinosinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459372/

  Sinusitis, also called rhinosinusitis, is the symptomatic inflammation of the paranasal sinuses and nasal cavity mucosa. Viruses, bacteria, fungi, or allergens may cause this inflammation. […] 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. […] 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.

• #5

• #6 Acute Sinusitis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/232670-overview

  The exact function of the paranasal sinuses is not well understood. The possible roles of the sinuses may include reducing the weight of the skull; dampening pressure; humidifying and warming inspired air; absorbing heat and insulating the brain; aiding in sound resonance; providing mechanical rigidity; and increasing the olfactory surface area.

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

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

  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 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.

• #9 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

  Sinusitis is inflammation of the paranasal sinuses due to viral, bacterial, or fungal infections or allergic reactions. […] 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. […] Chronic sinusitis involves many factors that combine to create chronic inflammation. Chronic allergies, structural abnormalities (eg, nasal polyps), environmental irritants (eg, airborne pollution, tobacco smoke), mucociliary dysfunction, and other factors interact with infectious organisms to cause chronic sinusitis. […] 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.

• #10 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

  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. […] The main complication of sinusitis is local spread of bacterial infection, causing periorbital or orbital cellulitis, cavernous sinus thrombosis, or epidural or brain abscess. […] Most acute sinusitis in immunocompetent patients is viral. […] Immunocompromised patients are at greater risk of aggressive fungal or bacterial infection.

• #11 Chronic Sinusitis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/232791-overview

  Most cases of chronic sinusitis are due to acute sinusitis that either is untreated or does not respond to treatment. […] The role of bacteria in the pathogenesis of chronic sinusitis is being reassessed. […] Current thinking supports the concept that chronic rhinosinusitis (CRS) is predominantly a multifactorial inflammatory disease. […] All of these factors can play a role in disruption of the intrinsic mucociliary transport system. […] This is because an alteration in sinus ostia patency, ciliary function, or the quality of secretions leads to stagnation of secretions, decreased pH levels, and lowered oxygen tension within the sinus. […] These changes create a favorable environment for bacterial growth that, in turn, further contributes to increased mucosal inflammation.

• #12 Recurrent Acute Rhinosinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459372/

  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.

• #13 Intra-operative biopsy in chronic sinusitis detects pathogenic Escherichia coli that carry fimG/H, fyuA and agn43 genes coding biofilm formation | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192899

  Intra-operative biopsy in chronic sinusitis detects pathogenic Escherichia coli that carry fimG/H, fyuA and agn43 genes coding biofilm formation. The aim of this study was to investigate whether or not surgical biopsy of sinus tissue in chronic sinusitis, not responsive to treatment, would detect E. coli. We intended to evaluate E. coli virulence genes, therefore dispute the causal role of such an unusual microorganism in chronic sinusitis, as well as consider effective pathogen-targeted therapy. […] The E. coli isolates belonged mainly to pathogenic phylogenetic group B2, and carried multiple virulence genes. Three genes in particular were present in all (100%) of examined isolates, they were (1) marker agn43 gene for forming biofilm, (2) type 1 fimbriae (fimG/H gene) and (3) yersiniabactin receptor (fyuA).

• #14 Intra-operative biopsy in chronic sinusitis detects pathogenic Escherichia coli that carry fimG/H, fyuA and agn43 genes coding biofilm formation | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192899

  The aim of this study was to investigate whether surgical biopsy of sinus tissue in chronic sinusitis, not responsive to antibiotic treatment, would detect E. coli, and to evaluate E. coli virulence genes, therefore dispute the unlikely pathogenic role of such an unusual microorganism in chronic sinusitis. […] The treatment of patients with chronic sinusitis is a daily challenge due to several factors that are responsible for the patho-physiology of this disease. […] Resolution of chronic sinusitis, following biopsy directed antibiotic therapy and FESS, suggested the contribution of E. coli, and perhaps its genetic make-up to be a direct causal factor of the pathogenesis of chronic sinusitis. […] Unexpectedly, 100% of E. coli isolated from examined patients carried agn43, fimG/H and fyuA genes, all of which are implicated in UTI. A pseudo-phylogenetic tree of virulence genes distribution revealed possible cooperation between agn43, fimG/H and fyuA.

• #15 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. […] Sinus infections caused by fungus are usually more serious than other forms of sinusitis. They’re more likely to happen if you have a weakened immune system. […] If you have a runny nose, stuffy nose and facial pain that don’t 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.

• #16

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

  Acute rhinosinusitis is defined as inflammation or infection of the mucosa of the nasal passages and at least one of the paranasal sinuses that lasts no longer than 4 weeks. […] Most cases of acute rhinosinusitis are due to respiratory viruses (98-99.8%), which include rhinovirus, parainfluenza virus, respiratory syncytial virus, and adenovirus. However, acute rhinosinusitis can occasionally be complicated by a bacterial infection and is diagnosed as acute bacterial rhinosinusitis. […] The most common precursor to acute bacterial rhinosinusitis is a viral upper respiratory tract infection followed by sinus obstruction from the mucosal edema of inhalant allergies and by anatomic factors (e.g., nasal polyps). Obstruction of the paranasal sinusal ostia impedes drainage of mucus secretions. Bacteria then grow in these secretions, irritating the underlying mucosa and producing more secretions. Death and sloughing of the mucosal cells occurs. The cells will regenerate after the infection has cleared.

• #17 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%). […] Although rare, fungal infections can also cause acute rhinosinusitis, though this is almost exclusively seen in the immunosuppressed (uncontrolled diabetes mellitus, HIV positive, oncology patients undergoing active treatment, and patients on immunosuppressants for an organ transplant or rheumatologic conditions). Typical species include Mucor, Rhizopus, Rhizomucor, and Aspergillus. It is very important to understand the difference between acute invasive fungal sinusitis (IFS) seen in these patients, and allergic fungal sinusitis (AFS) which presents in immunocompetent individuals as a mass-like lesion occupying a sinus cavity and often causes chronic symptoms. AFS will be discussed elsewhere and is beyond the scope of this article.

• #18

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

  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. […] 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. In chronic sinusitis, these organisms, plus Staphylococcus aureus, coagulase-negative Staphylococcus species, and anaerobic bacteria, are the most likely involved organisms.

• #19 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. […] Studies have shown that 70 percent of cases of community-acquired acute sinusitis in adults and children are caused by Streptococcus pneumoniae and Haemophilus influenzae. […] Despite the use of antibiotics and selected adjunctive therapy, 10 to 25 percent of primary care patients continue to have symptoms. The office re-evaluation of these patients, two to three weeks after the first visit, should include a careful history and physical examination, and a single Waters view of the sinuses should be taken to confirm the diagnosis. Empiric therapy may include a two-week course of a second-line antibiotic.

• #20 The incidence of anaerobic bacteria in adult patients with chronic sinusitis: A prospective, single-centre microbiological study in: European Journal of Microbiology and Immunology Volume 10 Issue 2 (2020)

  https://akjournals.com/view/journals/1886/10/2/article-p107.xml

  Chronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. […] The pathophysiology of this condition is still poorly understood, with multiple environmental, host and microbial factors being implicated: allergies are a common cause, and anatomical problems such as a deviated nasal septum can bring on chronic sinusitis, other suspected causes putative pathological factors include changes in the microbiota, imbalance of the local or systemic immune system, and the presence of moulds or other fungi in the sinuses. […] It has been suggested that anaerobic bacteria play a significant role in the pathogenesis of CRS. […] This may be the result of the selective pressure of antimicrobial agents, sometimes redundantly used in the management of acute viral sinusitis, that enables resistant anaerobic organisms to survive, and over time, for the development of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus cavity.

• #21 The incidence of anaerobic bacteria in adult patients with chronic sinusitis: A prospective, single-centre microbiological study in: European Journal of Microbiology and Immunology Volume 10 Issue 2 (2020)

  https://akjournals.com/view/journals/1886/10/2/article-p107.xml

  CRS caused by anaerobic bacteria is a particular concern clinically because many of very serious complications associated with this condition (spread of infection into the bones of the face, mucocele formation, osteomyelitis, meningitis and/or and brain abscess) are associated with these microorganisms. […] The evaluation of the pathogenic role of anaerobic bacteria in the acute exacerbation of CRS is of utmost importance. […] Our present study of adult CRS patients illustrates the importance of obtaining correct samples from patients with CRS for both aerobic and anaerobic cultures to guide the selection of the proper antimicrobial therapy and to prevent possible life threatening-sequelae.

• #22

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

  A distinct entity, allergic fungal sinusitis (AFS), occurs in immunocompetent patients and results from an immunologic reaction to fungi that colonize the sinuses. Most people tolerate exposure to mold spores in the air because they are ubiquitous in our environment. However, people with AFS develop a hypersensitivity reaction involving an intense eosinophilic inflammatory response to the fungus that has colonized the sinuses. […] Because of the extent of sinus blockage and the strong association with polyps, surgery is usually indicated to remove the inspissated allergic mucin and polyps, followed by systemic corticosteroids to decrease the inflammatory response.

• #23

  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. Deferoxamine is used to treat iron overload in patients receiving multiple blood transfusions. Deferoxamine chelates iron and deferoxamine-iron chelate, called feroxamine, is a siderophore for the species Rhizopus, increasing iron uptake by the fungus. This stimulates fungal growth and leads to tissue invasion. If the organisms get into the ethmoid sinuses the orbital regions can be affected. Intracranial spread can occur through the ophthalmic artery, superior fissure, or cribriform plate. The fungi invade the blood vessel lumina and cause thrombosis through inflammatory occlusion. Areas of ischemic infarction and necrosis will then appear in the infected tissue. Death may occur within 2 weeks if untreated or unsuccessfully treated.

• #24 Sinusitis (Sinus Infection) | ENT Condition | OneWelbeck

  https://onewelbeck.com/conditions/sinusitis-sinus-infection/

  Swelling of the lining of the nose can also be caused by irritants like air pollution, smoke and chemicals (e.g. some sprays containing pesticides), disinfectants and household detergents. Again, this can impair sinus drainage by narrowing or blocking the opening to the sinuses and in turn causes infection. […] Allergies can cause inflammation inside the nose as common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma and allergies are responsible for asthma in some patients. The nasal stuffiness experienced with allergies makes asthma more difficult to control. […] Narrowing of the nasal cavity can sometimes be caused by structural problems as a result of trauma or they can develop when growing. If the narrowing is severe then it causes a blockage with mucus building up behind it, leading to infection.

• #25 Sinusitis (Sinus Infection or Sinus Inflammation) | AAFA.org

  https://aafa.org/allergies/allergy-symptoms/sinusitis-sinus-infection/

  A viral infection causes most cases of sinusitis. […] If your sinuses are blocked for a long time, typically 10 days or more, you may get a bacterial infection. This secondary infection is caused by bacteria that are normally present in the respiratory tract. These bacteria multiply and cause a sinus infection when they are unable to drain out of the blocked, inflamed sinuses. […] Irritants like smoke, strong odors, and air pollution can also cause sinus swelling. […] Also, bodily defects such as a deviated nasal septum, nasal polyps, and narrowed sinus openings can contribute to sinus infections. […] Chronic sinusitis occurs when symptoms become more frequent or worse. Sinus infections may cause long-term sinus inflammation (swelling) and symptoms. […] If you have more than 3 sinus infections in a year or have symptoms longer than 12 weeks, you could have chronic sinusitis.

• #26 Chronic Sinusitis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/232791-overview

  Chronic sinusitis is an inflammatory process involving the paranasal sinus and persisting for at least 12 weeks. […] Chronic rhinosinusitis is one of the more common chronic diseases in the United States, and it affects those of all ages. […] Stasis of secretions inside the sinuses can be triggered by (1) mechanical obstruction at the ostiomeatal complex due to anatomic factors or (2) mucosal edema caused by various etiologies (eg, acute viral or allergic rhinitis). […] Mucous stagnation in the sinus forms a rich medium for the growth of various pathogens. […] The early stage of sinusitis is often a viral infection that generally lasts up to 10 days and that completely resolves in 99% of cases. […] However, a small number of patients may develop a secondary acute bacterial infection that is generally caused by aerobic bacteria (ie, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis).

• #27 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. […] Chronic infection can cause mucosal swelling and inflammation. […] Acute sinusitis is when symptoms are present for 4 weeks or less. It is caused by viruses or bacteria growing in the sinuses. […] Chronic sinusitis is when the symptoms and swelling of the sinuses is present for longer than 3 months. It may be caused by bacteria or a fungus. […] Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. […] Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

• #28 Sinusitis – Wikipedia

  https://en.wikipedia.org/wiki/Sinusitis

  Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include production of thick nasal mucus, nasal congestion, facial congestion, facial pain, facial pressure, loss of smell, or fever. […] Sinusitis is a condition that affects both children and adults. It is caused by a combination of environmental and a person’s individual health factors. […] Most cases are caused by a viral infection. […] Chronic rhinosinusitis is a multifactorial process hypothesized to be caused by inflammatory processes driven by dysfunction between local host and environmental interactions. […] It is divided into two phenotypes that depend on the presence or absence of nasal polyps. […] Chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps are thought to have two different inflammatory pathways, with the latter form driven by a Th1 response and the former driven by a Th2 response.

• #29 Frontiers | Pathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1139240/full

  The presence of a normal epithelium is fundamental for maintaining homeostasis in the nasal and paranasal sinuses. […] Our review provides sound evidence of the need for in-depth study of the pathophysiological alterations of this disease and for the development of novel epithelium-targeting alternative treatments. […] As CRS is a highly heterogeneous disease, its pathogenesis has not yet been well-elucidated. A number of factors have been found to be associated with the onset and development of CRS, including geographical and racial factors, environmental exposures, sinus microbiota dysbiosis, mucociliary clearance (MCC) dysfunction, epithelial barrier impairment, and disrupted immune response. […] Essentially, the sinonasal epithelium plays a key role in both innate and adaptive immunity. However, abnormal capability of the epithelium can have a significant impact on the onset and development of CRS.

• #30 Sinusitis – Wikipedia

  https://en.wikipedia.org/wiki/Sinusitis

  Both pathways result in an increase in inflammatory molecules (cytokines). […] The Th1 response is characterized by secretion of interferon gamma. […] The Th2 response is characterized by secretion of interleukin-4 receptor, interleukin 5, and interleukin 13. […] Both forms of chronic rhinosinusitis are considered to be highly heterogenous, each with the ability to demonstrate three inflammatory endotypes, the third being a Th17 response. […] Exposure to fine particulate matter (PM2.5), which consists of particles less than 2.5 micrometers in diameter, has been associated with an increased risk of developing rhinosinusitis. […] The fine particles cause oxidative stress and inflammation, contributing to the pathogenesis of rhinosinusitis.

• #31 Frontiers | Pathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1139240/full

  Epithelial-to-mesenchymal transition (EMT), mucosal remodeling, and autophagy have been commonly observed in CRS, presenting new insight into sinonasal epithelium malfunction; these phenomena might have some connection with the pathogenesis of this disease. […] The optimal treatment of CRS has undoubtedly been found to be complicated due to its multifactorial pathogenesis. […] However, this option does not provide effective prevention of relapse of the disease. […] The impact of traditional and developing therapeutic approaches on the sinonasal epithelium is discussed in this section. […] The medical treatment of CRS mainly involves the application of topical, intranasal, and oral corticosteroids. […] Corticosteroids predominantly act on the glucocorticoid receptors (GCRs) distributed in sinonasal epithelial cells and exert powerful anti-inflammatory effects. […] Corticosteroids can also suppress eosinophils and Th2 cells but are relatively less effective on neutrophils and the Th17 subset.

• #32 Frontiers | Pathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1139240/full

  Chronic rhinosinusitis (CRS) is a clinical syndrome primarily characterized by long-term mucosal inflammation of the nasal cavity and sinuses. The pathogenesis of CRS is still unclear due to its high heterogeneity. […] Undoubtedly, epithelial dysfunction plays a vital role in the onset and development of CRS. […] Impaired mucociliary clearance (MCC) and an abnormal sinonasal epithelial barrier are usually considered to be the main causative factors in CRS. Epithelial-derived bioactive substances, such as cytokines, exosomes, and complements, play a vital role in the regulation of innate and adaptive immunity and contribute to the pathophysiological alterations of CRS. […] The phenomena of epithelial–mesenchymal transition (EMT), mucosal remodeling, and autophagy observed in CRS offer some novel insights into the pathogenesis of this disease.

• #33 Frontiers | Pathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1139240/full

  Chronic rhinosinusitis is a multifactorial disease with limited treatment options. Epithelial disorder is pivotal in the etiology or pathogenesis of CRS; epithelial barrier disruption and MCC dysfunction constitute the fundamental pathogenesis of CRS. […] Overall, considering the importance of sinonasal epithelium-mediated immunity disorders for CRS pathogenesis, vigorous efforts should be applied to the development of novel biological agents that can antagonize the actions of inflammatory bioactive components produced by the epithelium, maintain the immune balance of the nasal mucosa, alleviate local inflammation, and reduce nasal polyp formation.

• #34 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 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. The orbit is the most common site due to the very thin ethmoid bone that separates infections from the ethmoid to the orbit. The Chandler classification is the most common method or grading orbital complications of sinusitis infection (listed from least to most severe).

• #35 Sinusitis: Symptoms, Causes, Treatments & Chronic Sinusitis vs. Sinusitis Infection

  https://resources.healthgrades.com/right-care/ear-nose-and-throat/sinusitis

  In some people, sinusitis can break down the body’s defenses and lead to more serious infections. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of sinusitis can be life-threatening and include: abscesses of the bones around the sinuses, brain abscess, cavernous sinus thrombosis, meningitis, and orbital cellulitis.

• #36

  https://newsroom.uw.edu/news-releases/chronic-sinus-inflammation-appears-alter-brain-activity

  Chronic sinus inflammation appears to alter brain activity. New research links sinus inflammation with alterations in brain activity, specifically with the neural networks that modulate cognition, introspection and response to external stimuli. This is the first study that links chronic sinus inflammation with a neurobiological change. We know from previous studies that patients who have sinusitis often decide to seek medical care not because they have a runny nose and sinus pressure, but because the disease is affecting how they interact with the world: They can’t be productive, thinking is difficult, sleep is lousy. It broadly impacts their quality of life. Now we have a prospective mechanism for what we observe clinically. The magnitude of brain-activity differences seen in the study group paralleled the severity of sinus inflammation among the subjects. The subjective feelings of attention decline, difficulties to focus or sleep disturbances that a person with sinus inflammation experiences might be associated with subtle changes in how brain regions controlling these functions communicate with one another. It is plausible that these changes may cause more clinically meaningful symptoms if chronic sinusitis is left untreated. It is also possible that we might have detected the early markers of a cognitive decline where sinus inflammation acts as a predisposing trigger or predictive factor.

• #37 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

  Sinusitis is a common condition with various forms and different etiologies. […] 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.

• #38 Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-5-28

  The pathogenesis of UC in some patients may be associated with their pre-existing CRS by a mechanism of swallowing sinusitis-derived SEB. […] We speculate that SEB initiates inappropriate immune reactions and inflammation in the colonic mucosa that further progresses to UC. […] Based on clinical observations, we hypothesized that sinusitis-derived SEB played a role in the pathogenesis of chronic inflammation in the intestinal mucosa via impairing the epithelial barrier function and inducing inappropriate immune reactions. […] The present data show high levels of SEB in the sinus wash fluids from the patients with UC-CRS. […] It is quite possible that the SEB-containing secretions released from sinuses were swallowed and contribute to the pathophysiological changes in the colonic mucosa.

• #39 Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-5-28

  The different outcome between the two groups of patients that supports our hypotheses that CRS derived SEB plays a certain role in the pathogenesis of UC in these patients. […] The phenomenon indicates that there are anti-SEB antibody-bearing cells in the colonic mucosa of these patients. […] SEB from S. aureus is discharged to the nasal cavity from the sinuses, swallowed into the gastrointestinal tract, where the SEB is absorbed by the intestinal epithelial cells via a Toll like receptor (TLR) 2-mediated mechanism. […] SEB plays an important role in the pathogenesis of chronic inflammatory intestinal disorders. […] The present study shows mast cell activation in colonic biopsies in response to SEB stimulation ex vivo by showing release of both tryptase and histamine, is consistent with previous reports. […] The results implicate that when CRS-derived SEB arrives in the colon of these patients with UC-CRS, it will disturb intestinal mucosal function as described below.

• #40 Sinus Disease | Mass Eye and Ear

  https://www.masseyeandear.org/conditions/sinus-disease?TRILIBIS_EMULATOR_UA=aqklj%3D

  Sinus disease (rhinosinusitis or commonly known as sinusitis) is caused by inflammation of the sinuses and the nose. […] Acute sinusitis is an inflammation of the cavities around your nasal passages (sinuses) caused by a variety of infections, including the common cold, a bad viral upper respiratory infection (URI) or bacteria. This is what is commonly known as a sinus infection. […] Acute rhinosinusitis is typically caused by a virus and lasts 7 to 14 days. Antiviral medication is not needed to fight these viral infections, as the body is able to fight them on its own. […] More rarely, these viral infections can create an environment that allows bacteria to grow, sometimes resulting in a bacterial sinus infection. […] If symptoms of discolored nasal drainage persist for 10 to 14 days, an antibiotic may be prescribed to treat the bacterial infection.

• #41 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.

• #42 Acute Bacterial Rhinosinusitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/acute-bacterial-rhinosinusitis-1.html

  Acute bacterial rhinosinusitis (ABRS) is an infection of both your nasal cavity and sinuses. It is caused by bacteria. The bacterial infection happens after the lining is already inflamed. This inflammation is often caused by a virus. […] ABRS sets in when your nasal cavity and sinuses first become inflamed from another cause, often a viral infection.

• #43 Treating acute sinusitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/treating-acute-sinusitis-3.html

  Infections in the nose involve the sinuses because the lining of the nose and the paranasal sinuses is continuous. […] Acute sinusitis usually follows an acute upper respiratory tract infection (common cold). As the viral infection spreads in the nasal mucosa, swelling and oedema of the mucosa results. […] Obstruction of the sinus ostia results. In addition, the viral infection may reduce normal cilial motility. This prevents normal muco-ciliary clearance resulting in an accumulation of mucus in the sinuses and the development of the symptoms of sinusitis. If this mucus becomes secondarily infected by bacteria, acute bacterial sinusitis develops.

• #44 Acute Sinusitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15285-acute-sinusitis

  Acute sinusitis is a short-term sinus infection (sinusitis). […] Sinusitis happens when bacteria and viruses settle in your sinuses, making their tissues swell. At the same time, your sinuses make more mucus. Normally, mucus flowing away from your sinuses washes away intruders. But when your sinus tissues swell, that mucus becomes trapped. […] Your sinuses become blocked and fill up with fluid, making your nose feel clogged up or stuffy. Your face may feel tender to the touch and you may develop a sinus headache. […] A healthcare provider may prescribe antibiotics if you have acute sinusitis from a bacterial infection. Often, providers will take a wait-and-see approach before prescribing antibiotics. In general, acute sinusitis symptoms that last 10 or more days may be signs of bacterial infection.

• #45 Sinusitis – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

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

  Treatment of acute sinusitis is aimed at improving sinus drainage and curing the infection. […] When antibiotics are not effective, surgery may be performed either to wash out the sinus and obtain material for culture or to improve sinus drainage, which allows the inflammation to resolve. Nasal obstruction that interferes with drainage may also require surgery. […] Invasive fungal sinusitis is a very serious disorder that develops most often in people whose immune system is impaired by chemotherapy or by diseases such as poorly controlled diabetes, leukemia, lymphoma, multiple myeloma, or AIDS. It may spread rapidly. […] Allergic fungal sinusitis is a chronic sinusitis in which fungi cause an allergic reaction characterized by marked nasal congestion and the formation of nasal and sinus polyps.

• #46 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

  Another factor associated with COVID-19 and severe disease is the increased expression of the transmembrane serine protease 2 (TMPRSS2) and receptor-angiotensin converting enzyme II (ACE2) in the nasal cavities of patients with chronic rhinosinusitis due to their significant reported roles in SARS-CoV-2 transmission and entry. […] Furthermore, upregulating the expression of ACE2 might also occur during these inflammatory responses secondary to increased expression of proinflammatory cytokines, including interferons. […] The current literature review discussed the association between COVID-19 and chronic sinusitis and AIFR. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed.

• #47 Sinusitis: The Pathophysiology, Clinical Manifestations and Diagnosis | Open Access Journals

  https://www.rroij.com/open-access/sinusitis-the-pathophysiology-clinical-manifestations-and-diagnosis.php?aid=93587

  The pathophysiology of sinusitis involves inflammation and obstruction of the paranasal sinuses, which can be triggered by a variety of factors, including infections, allergies, structural abnormalities, and irritants. Understanding the underlying causes and mechanisms of sinusitis is crucial for accurate diagnosis and appropriate management, which may include treatments aimed at reducing inflammation, improving drainage, or addressing specific causes like bacterial infections or allergies.

• #48 Sinus Infection (Sinusitis) | MicroGen Diagnostics

  https://microgendx.com/patients/sinus-infection-sinusitis/

  A sinus infection, also known as sinusitis, is an inflammation, or swelling, of the tissue lining your sinuses, which are connected spaces in your head behind your forehead, eyebrows, cheeks, and nose. Your sinuses are normally filled with air but can become infected when they become blocked, and fluid builds up. This fluid buildup allows germs to grow. Bacteria as well as viruses and a fungus such as mold can cause a sinus infection. […] Sinusitis is treated in several ways, depending on how severe it is. A mild sinusitis infection is treated with over-the-counter cold and allergy medications or nasal saline irrigation. You should not use nonprescription sprays or drops for longer than three to five days because they can increase rather than decrease congestion. […] Knowing what kind of bacteria, virus, or fungus is causing the infection can result in more effective therapy. It is important to know that not all antibiotics work for all bacteria, and some even work differently in different areas of the body. In addition, a fungal sinus infection should be treated with antifungal medication rather than antibiotics. Some forms of fungal sinus infections do not respond to antifungal medication and require the use of oral steroids instead. Your doctor should consult the „antimicrobials for consideration” chart on your MicroGenDX report to decide which treatment is right for you.

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

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

  Antibiotics appear to be of little benefit in the treatment of chronic sinusitis. Recurrent or chronic sinusitis often requires otolaryngology consultation. CT imaging of the osteomeatal complex followed by functional endoscopic sinus surgery (FESS) often successfully restores the physiology of sinus aeration and drainage. Between 80 and 90 percent of FESS patients experience significant improvement of symptoms.

• #50 What is Chronic Sinusitis? Symptoms and Causes | UC Health

  https://www.uchealth.com/en/conditions/chronic-sinusitis

  Research being performed by our physicians is in the process identifying the inflammatory mechanisms of chronic sinusitis. While the causes of chronic sinusitis are currently unknown, there are factors that are known to be associated with chronic sinusitis. […] If medical treatments are not enough to control your symptoms of chronic sinusitis, you may be a good candidate for endoscopic sinus surgery. Previous studies have established parameters for patients who may most benefit from endoscopic sinus surgery, and our providers can discuss these with you. The extent of surgery depends on the severity of the chronic sinusitis and which sinuses are involved. Your doctor will tell you more about your options. During endoscopic sinus surgery, the doctor uses a small camera (endoscope) to navigate inside the nose and sinuses, and to open the sinuses while removing diseased tissue (like polyps) and eradicating infection. This surgery is minimally invasive and is done without incisions on the face.

• #51 Managing sinus issues | Immune Deficiency Foundation

  https://primaryimmune.org/resources/news-articles/managing-sinus-issues

  Unfortunately, theres no cure for sinus disease so we basically have to think out of the box and, as in everything in medicine, certain people respond better to different therapies, so we have to find the recipe that works for you, said Kleiner. […] Those with chronic sinusitis may want to consider surgery, though in most academic centers, sinus surgery is reserved only for cases in which conservative management, such as antibiotics and allergy treatments, has failed. […] Another type of sinus surgery is the Propel sinus stent in which a steroid implant is inserted into the sinuses and dissolves over time as it decreases inflammation. […] Kleiner said that sinus ventilation and drainage are sometimes more helpful than drugs.

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