- The vast majority of cases of acute rhinosinusitis are self-limiting viral events.
- Chronic rhinosinusitis is an inflammatory disease whose causes are often multifactorial.
- In chronic rhinosinusitis, nasal endoscopy and/or CT scan may be necessary to make the diagnosis if symptoms do not correlate well with findings.
Rhinosinusitis is one of the most commonly diagnosed medical conditions in the United States, affecting an estimated 16% of the adult population annually. Direct health care costs are significant, estimated to be over $5.8 billion per year. According to the recent 2007 data from the National Health Interview Survey, rhinosinusitis continues to be one of the top 10 leading diagnoses of office visits in the United States. Of all antibiotics prescribed in 2002, 9% of pediatric prescriptions and 18% of adult prescriptions were written for a diagnosis of acute sinusitis.
Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol 2004;193(Suppl):S3–S5. (This article sheds light on the enormous direct and indirect costs associated with sinusitis.)
Glikilich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg 1995;113:104–109. (The authors demonstrate the significant national health impact of chronic sinusitis.)
Rhinosinusitis is broadly defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. The term rhinosinusitis is used because sinusitis is almost always accompanied by inflammation of the contiguous nasal mucosa. There have been a number of iterations of the actual definition that are described in this section. The Rhinosinusitis Task Force in 1997 classified rhinosinusitis based on both symptom duration and by history. A history suggestive of rhinosinusitis includes two or more major factors, or one major and two minor factors (Table 15–1). In 2003, another task force that included the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) proposed revised guidelines that required physical exam findings for the diagnosis of chronic rhinosinusitis (CRS). Findings on nasal endoscopy or anterior rhinoscopy should include one or more of the following: purulent drainage, polyps, polypoid changes in the mucosa, and edema or erythema of the middle meatus. These guidelines also suggest that CT scans can be a helpful to confirm the diagnosis of symptomatic patients with equivocal physical exam findings. In 2004, a multidisciplinary panel further classified CRS as CRS with nasal polyps, CRS without nasal polyps, and allergic fungal rhinosinusitis (AFS) to better guide clinical research and patient care.
Table 15–1. Major and Minor Factors in the Diagnosis of Rhinosinusitis (1997 Task Force). |Favorite Table|Download (.pdf)
Table 15–1. Major and Minor Factors in the Diagnosis of Rhinosinusitis (1997 Task Force).
- Facial pain or pressure
- Facial congestion or fullness
- Nasal obstruction or blockage
- Nasal discharge, purulence, or discolored postnasal drainage
- Hyposmia or anosmia
- Purulence in nasal cavity
- Fever (in acute rhinosinusitis only)
- Fever (in chronic sinusitis)
- Dental pain