Sinusitis (synonyms: catarrhal sinusitis; sphenoid sinusitis; maxillary sinus infection; frontal sinusitis; frontal sinus infection; frontal sinus catarrh; frontal sinusitis; ICD-10 J32.-: Chronic sinusitis; English : acute rhinosinusitis (ARS); chronic rhinosinusitis (CRS); J01.-: Acute sinusitis) is an inflammatory change of the mucous membranes of the paranasal sinuses. It is a common condition and the cause of many visits to the doctor. The following sinuses may be affected:
- Sinusitis maxillaris (maxillary sinus).
- Sinusitis ethmoidalis (ethmoidal cells).
- Sinusitis frontalis (frontal sinus)
- Sinusitis sphenoidalis (sphenoid sinus)
In children, the most commonly affected are the ethmoid cells, whereas in adults there is usually inflammation of the maxillary sinus. If all sinuses are affected, this is called pansinusitis. Acute sinusitis is distinguished from chronic sinusitis (duration 2-3 months). In adults, acute sinusitis is caused by Streptococcus pneumoniae or Haemophilus influenzae in more than 60% of cases. The most common pathogens of chronic sinusitis are Staphylococcus aureus, various Enteroba-ceriaceae, less frequently Pseudomonas aeruginosa and anaerobes of the oral flora. Viruses such as rhino- and adenoviruses can also cause sinusitis. Rhinosinusitis is said to occur when there is simultaneous rhinitis (inflammation of the nasal mucosa) and sinusitis (inflammation of the mucosa of the paranasal sinuses). A distinction is made between:
- Acute rhinosinusitis (ARS) – inflammation-related drainage disorder and disturbed ventilation of the paranasal sinuses; maximum 12 weeks; complete resolution of symptoms.
- Recurrent ARS – definition of ARS according to AWMF (see below): at least 4 episodes of ARS in the period of 12 months (calculated from the first episode) with intermediate complete symptom regression.
- Chronic rhinosinusitis (CRS) – defined as persistence of nasal obstruction and/or secretion problems > 12 weeks; possibly accompanied by cough, facial pain or pressure, and/or olfactory impairmentDefinition of CRS according to S2k guideline (see below): persistent symptoms > 12 weeks
Legend: cNP with (cum) nasal polyps; sNP without (sine) nasal polyps.
Seasonal accumulation of the disease: sinusitis occurs clustered in the wet and cold season. Transmission of the causative agent (route of infection) is aerogenic (airborne droplet infection). The incubation period (time from infection to onset of the disease) varies. In acute sinusitis, it is usually 7-10 days. Peak incidence: acute sinusitis occurs predominantly in the 5th decade of life. In children, 7 to 10 rhinosinusitides are observed per year. In adults, there are approximately 2 to 5 (estimated). Chronic sinusitis is found almost exclusively in young children. The prevalence (disease incidence) of sinusitis is 16.3% of adults (in the United States). The prevalence of chronic rhinosinusitis (CRS) is estimated to be 5-15% of the population. CRScNP affects approximately 1-4% of the general population. Course and prognosis: If sinusitis is treated in a timely manner, the course is favorable. Acute sinusitis/acute rhinosinusitis (ARS) shows the following spontaneous healing rates: 2 weeks 60-80 % , 6 weeks 90 %. Complications are rare.In uncomplicated viral rhinosinusitis, improvement usually occurs within seven to ten days. If the affected person has anatomical constrictions in the area of the paranasal sinuses, the sinusitis usually occurs recurrently (recurring), because the natural self-cleaning and the defense of the sinus mucosa are hindered by the constriction. Following chronic sinusitis/chronic rhinosinusitis (CRS), scarring or polyps may develop.CRS is associated with a significant decrease in quality of life, sleep quality, and daily functioning. Note: According to a cohort study, patients with unilateral CT findings with primary intervention most commonly had a diagnosis of chronic rhinosinusitis without polyps (21%), followed closely by malignancy/malignant tumors (19%), followed by benign (benign) tumors (15%) and allergic fungal (fungal-related) sinusitis (10%). Comorbidity: Approximately 40% of patients with CRScNP (with (cum) nasal polyps) also suffer from bronchial asthma.
