Rhinosinusitis, or inflammation of the nasal mucosa, is a common inflammatory change of the nasal mucosa with concomitant inflammation of the sinus mucosa. In most cases, rhinosinusitis can be attributed to a viral infection.
What is rhinosinusitis?
Rhinosinusitis is the term used to describe inflammation of the nasal mucosa (rhinitis) in combination with inflammatory changes in the mucosa (mucous membrane) of the paranasal sinuses (sinusitis). Depending on the time course, a distinction is generally made between an acute and a chronic variant, with chronic rhinosinusitis being referred to from a complaint duration of more than 12 months. In addition, a distinction is made in chronic rhinosinusitis between the polyp-forming form and rhinosinusitis without manifestation of polyps. Acute rhinosinusitis is manifested by purulent nasal secretions, nasal obstruction, and a feeling of pain and pressure in the facial region. In contrast, the chronic form of rhinosinusitis is less prominent in many cases and manifests itself, in addition to the more discrete acute symptoms, by an increased susceptibility to infection, a general state of fatigue, and reduced exercise tolerance.
Causes
Acute rhinosinusitis represents an inflammatory change following a nasal infection that results in drainage obstruction as well as impaired ventilation in the paranasal sinuses. Increasing obstruction and tissue formation leads to impaired ventilation and drainage and the development of the chronic form. In most cases, the infection is triggered virally by influenza, parainfluenza, or rhino-influenza viruses and bacterially by Mycoplasma and Chlamydia pneumoniae. In addition, the bacterial pathogens Haemophilus influenzae and Streptococcus pneumoniae can lead to superinfection following a viral infection. Chronic rhinosinusitis is associated with Staphylococcus aureus, Staphylococcus epidermidis, Moraxella catarrhalis, and enterobacteria, among others. The polyp-forming form of chronic rhinosinusitis is also associated with intolerance to acetylsalicylic acid, bronchial asthma, and noninvasive fungal infections. Anatomic changes in the lateral nasal wall and allergic rhinitis are considered to be promoting factors, especially for recurrent rhinosinusitis.
Symptoms, complaints, and signs
Rhino-sinusitis is also known as sinusitis. It presents as a mixture of runny nose and blocked tubes. Medical professionals refer to it as nasal obstruction and rhinorrhea. Rhino-sinusitis can develop different degrees of severity. These can be determined by the symptoms. Chronicity of rhino-sinusitis is possible. The blocked nose may cause disturbances in the perception of smell. The pressure in the tubes may be increased. This results in symptoms such as headaches, feelings of pressure in the jaw and forehead area and on both sides of the nasal root. At the same time, the nose runs constantly. The duration of acute rhino-sinusitis is set at about 14 to 18 days. Frequent sneezing may accompany these symptoms. Nocturnal coughing irritation results from postnasal secretion. Often, the nose is stuffy on one side at night. This makes breathing difficult. Due to the stuffy nose, pressure on the tubes and the nocturnal cough irritation, healthy sleep is disturbed. The sleeper breathes through the mouth or snores. Both can dry out or chill the airways. As rhino-sinusitis progresses, symptoms may worsen and fever may develop. Rhino-pharyngitis may develop, with severe hoarseness and voice problems. Because so many symptoms can occur, the most distressing symptom is critical for treatment.
Diagnosis and course
Rhinosinusitis is diagnosed based on characteristic clinical symptoms (including inflammatory changes in the nasal mucosa, nosebleeds, marked pain, swelling, visual impairment, and sensory disturbances in the trigeminal region). Additionally, in many cases of rhinosinusitis, pus (pus) can be detected by rhinoscopy or computed tomography. Nasal endoscopy allows differential assessment of the nasal and paranasal mucosal structure.In terms of differential diagnosis, a distinction should also be made between bacterial and viral rhinosinusitis with regard to the therapeutic measures to be selected, whereby the duration of the disease and its manifestation allow initial conclusions to be drawn. If rhinosinusitis is diagnosed early and treated consistently, the disease has a complication-free course. If left untreated, a pronounced rhinosinusitis can affect adjacent structures such as the eyes, meninges or brain and, in extreme cases, lead to life-threatening meningitis or encephalitis. Complications are sometimes possible as a result of rhinosinusitis. For example, there is a risk that the infection will spread from its site of origin to neighboring regions of the body.
Complications
Normally, acute inflammation of the sinuses and nasal mucosa heals completely. However, some affected individuals suffer from severe rhinosinusitis several times a year. It is possible for acute rhinosinusitis to develop into a chronic form. This is when the symptoms persist for more than two months. The possible consequences of rhinosinusitis include inflammation of the nasal cavity wall. If this even breaks through, there is a risk of the infection spreading to all adjacent organs. Therefore, there is a risk of dangerous purulent meningitis (meningitis purulenta). If the inflammation extends further into the eye socket, eyelid edema may occur. Furthermore, it is conceivable that the eyeball protrudes. If visual disturbances also occur, an immediate surgical intervention in the responsible sinus usually has to be performed. Further sequelae of rhinosinusitis often affect the respiratory system. Thereby, chronic bronchitis and bronchial asthma are threatening. In addition, chronic rhinosinusitis is considered a risk factor for chronic obstructive pulmonary disease (COPD). Bony complications also occur in five to ten percent of all patients due to sinusitis. These include, above all, frontal bone osteomyelitis. In addition, chronic rhinosinusitis carries the risk of tumor formation in the nasopharynx.
When should you see a doctor?
When nasal breathing is severely obstructed and typical accompanying symptoms of rhinosinusitis occur, there is every reason to see a doctor. In case of pressure headaches, increased secretion production or chronic pain in the area of the paranasal sinuses, a medical professional should be consulted immediately. This is particularly necessary if the complaints do not subside on their own or even become more severe. Smokers and allergy sufferers are particularly at risk. Likewise, people with genetic predispositions as well as caries patients are among the risk groups who should talk to their family doctor if they experience the symptoms mentioned above. Poor nutrition and alcohol consumption are further risk factors that need to be clarified. In addition to the general practitioner or pediatrician, an ear, nose and throat specialist or allergist can be consulted. In the case of chronic symptoms, regular visits to the doctor are indicated so that a rapid response can be made in the event of complications. If rhinosinusitis is diagnosed early and is well monitored from then on, the prognosis for a quick recovery is positive. Therefore, even the first signs should be clarified if a serious disease of the nose or sinuses is suspected.
Treatment and therapy
Therapeutic measures for rhinosinusitis depend on the specific cause present as well as the form, course, and symptoms. Analgesics or anti-inflammatories such as ibuprofen, paracetamol, or diclofenac may be used to reduce pain. In addition, antibiotic therapy with amoxicillin or aminopenicillin may be indicated in severe cases of bacterial acute rhinosinusitis. Bacterial chronic rhinosinusitis can also be treated in the long term with antibiotics in combination with steroids. In addition, decongestants (decongestant nasal sprays or drops) can be used for symptomatic therapy in the short term (7 to 10 days) for acute rhinosinusitis. In the presence of chronic rhinosinusitis with polyposis, topically applied nasal corticosteroids can support symptom improvement (pain reduction, decrease in obstruction and purulent secretions). In affected allergic patients, supportive antihistamine therapy may be indicated.Furthermore, phytotherapeutics such as Myrtol or Cineol can be applied symptom-relieving and curative in non-bacterial acute rhinosinusitis, while additive therapy with Sinupret (primrose mixture) can be used in case of bacterial acute rhinosinusitis. The phytotherapeutics Pelargonium sidoides and Bromelaine are also thought to have an additive therapeutic effect in acute rhinosinusitis. In chronic rhinosinusitis, the application of saline solutions is also recommended to improve mucociliary clearance (self-cleaning of the bronchi). If no improvement of symptoms can be observed within the framework of conservative therapy measures, surgical intervention may be indicated, especially in cases of impaired ventilation and drainage or impending inflammatory complications. Minimally invasive endoscopic paranasal sinus surgery is aimed at reconstructing nasal physiology by focal decontamination, removal of hyperplastic or pathologically altered mucosal areas, and polypectomy (polyp resection). Topical corticosteroid application is recommended after surgery to prevent recurrence of rhinosinusitis.
Prevention
Rhinosinusitis can be prevented by early and consistent therapy of the triggering underlying disease, especially an influenza infection. In addition, the risk of rhinosinusitis can be reduced by prophylactic measures (flu vaccinations, frequent hand washing, avoidance of nasal mucosa irritation, sufficiently humidified room air) against bacterial or viral infections, especially during the cold season. Acute rhinosinusitis usually does not require follow-up care. Thus, the acute form heals after a few weeks without the need for further drug treatments. However, if a chronic form of progression is present that leads to surgery, follow-up treatment is considered important.
Follow-up care
After any surgery on the paranasal sinuses, local changes in the mucosa appear. To positively influence wound healing, tamponades are placed in the mucosa of the nose and sinuses. The tamponades fulfill the function of stopping diffuse oozing bleeding of the mucosa. The tamponades dissolve by themselves after a few days or are removed by the doctor. They have the advantage of stopping the bleeding, but often produce an unpleasant feeling of pressure in the nose. For this reason, tamponades made of self-dissolving materials are increasingly being used. Once the tamponades have been removed, gentle, endoscopy-assisted follow-up treatment of the wound surfaces is performed. The extent of the therapy depends on the course of wound healing. Endoscopic control makes it possible to visualize changes that occur during the wound healing process. In addition, the ethmoid shaft is suctioned every two days and a free access to the frontal sinus is made. If inflammatory changes occur, antibiotic medications are administered. Nasal sprays containing topical glucocorticoids may be used to counter edema formation. Saline irrigation is considered helpful against recurrences.
Here’s what you can do yourself
Rhinosinusitis must first be clarified by a doctor. The specialist can prescribe a suitable preparation and tell the patient the first means and measures for self-treatment. Accompanying this, the affected person should take it easy. Regular breaks should be taken during work. It is also advisable to drink sufficient water, tea or spritzers and, if necessary, to take zinc or vitamin C supplements. Nicotine and other stimulants are best avoided in the first days and weeks after diagnosis. Home remedies such as ointments or inhalation baths can also be used to support the treatment and reduce the symptoms. If the symptoms do not subside despite all the measures taken, the patient may have a chronic sinusitis. A doctor must make the diagnosis quickly and prescribe suitable medication. Otherwise, complications such as spread of the inflammation or injuries in the area of the maxillary sinus may occur. In case of complications, surgery may be required. After a surgical procedure, the physician’s instructions regarding diet, rest, and taking medications must be followed first and foremost. The rhinosinusitis and any accompanying symptoms should then subside completely within a few weeks.
