General Medical Information

Rhinosinusitis

Shawn D. Newlands

The presence of cloudy, discolored or foul-smelling nasal discharge helps differentiate rhinosinusitis from other causes of rhinitis (see Chapter 30). Symptoms are acute or chronic and bilateral or unilateral. Symptoms of chronic rhinosinusitis include, in decreasing order of frequency, nasal congestion, purulent nasal discharge, post-nasal discharge with cough, facial pressure or pain, and olfactory changes.

Fungal infection of the lateral nasal wall and paranasal sinuses can be associated with nasal obstruction. Mucormycosis, which occurs most often among patients with poorly managed diabetes, is a pale (early) or dark (late) area in the lateral nasal wall. Computed tomography (CT) of the affected side often shows marked inflammation of the sinus mucosa or opacification of the sinus. The diagnosis is confirmed by means of identifying the pathologic organism with methenamine silver staining. Invasive aspergillosis, a disease caused by Aspergillus fungi and marked by granulomatous lesions in the paranasal sinuses, can be managed by means of removal of the affected tissue. Although removal of infected soft tissue often is curative, bony invasion presents the physician with a more serious situation. These conditions warrant aggressive surgical treatment and careful follow-up evaluation. Invasive aspergillosis among immunosuppressed patients, particularly patients who have undergone bone marrow transplantation, is aggressive and often fatal. Therapy for mucormycosis and invasive aspergillosis is wide surgical débridement and tight control of diabetes or reversal of immunosuppression. Good outcomes are rare without quick control of the predisposing factors.