General Medical Information

Rhinosinusitis: Current Concepts And Management

A. Daniel Pinheiro
George W. Facer
Eugene B. Kern

Rhinosinusitis is defined as any inflammation of the mucosal lining of the sinuses. The most common inflammation of the paranasal sinuses and the nose is the common cold. Various aspects of acute, subacute, and chronic suppurative bacterial rhinosinusitis are discussed in this chapter, including predisposing factors, pathophysiologic mechanisms, differential diagnosis, medical management, and complications.

Sinusitis is the most common health care problem in the United States. It affects more than 31 million persons a year. Americans spent approximately $150 million in 1989 for products recommended or prescribed by physicians for management of sinusitis. Acute sinusitis rarely is limited to one sinus. The long-accepted concept that most of sinus disease involves the maxillary sinus has been replaced by the concept that disease primarily involves the ostiomeatal complex. Emphasis has been placed on early recognition of predisposing factors in the development of sinusitis. The diagnosis of acute sinusitis usually is not difficult; however, the diagnosis of chronic sinusitis may be more challenging because it can masquerade as other conditions. Family practitioners, pediatricians, pediatric allergists, and otorhinolaryngologists have become increasingly aware of the possibility of sinusitis, especially among children. Advances in computed tomography (CT) and nasal endoscopy have helped improve the understanding and diagnosis of sinusitis.