Rhinosinusitis affects many people, and thus, it is a common presentation in primary care. Despite this fact, rhinosinusitis is often overlooked in undergraduate and postgraduate training. Management of rhinosinusitis places a significant burden on both primary and secondary care, with significant financial implications. This article aims to outline the classification, epidemiology, pathophysiology, clinical diagnosis and treatment of rhinosinusitis, in particular identifying red flag symptoms and indications for referral to secondary care.
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References
1.
Ahovuo-SalorantaA.BorisenkoO. V.KovanenN.VaronenH.RautokorpiU. M.WilliamsJ. W.JrMakelaM. (2008) Antibiotics for acute maxillary sinusitis. Cochrane Database of Systematic Reviews2. CD000243. doi: 10.1002/14651858.CD000243.pub2.
2.
BachertC.HormannK.MosgesR.RaspG.RiechelmannH.MullerR.RudackC. (2003) An update on the diagnosis and treatment of sinusitis and nasal polyposis. Allergy58(3): 176–191. doi: 10.1034/j. 1398-9995.2003.02172.x.
3.
BrozekJ. L.BousquetJ.Baena-CagnaniC. E.BoniniS.CanonicaG. W.CasaleT. B.SchunemannH. J. (2010) Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. The Journal of Allergy and Clinical Immunology126(3): 466–476. doi: 10.1016/j.jaci.2010.06.047.
4.
ChandlerJ. R.LangenbrunnerD. J.StevensE. R. (1970) The pathogenesis of orbital complications in acute sinusitis. Laryngoscope80(9): 1414–1428. doi: 10.1288/00005537-198009000-00007.
5.
ChoiS. M.ParkJ. E.LiS. S.JungH.ZiM.KimT. H.BaoyanL. (2013) A multicenter, randomised, controlled trial testing the effects of acupuncture on allergic rhinitis. Allergy68(3): 365–374. doi: 10.1111/all.12053.
6.
ErekosimaN.Suarez-CuervoC.RamanathanM.KimJ. M.ChelladuraiY.SegalJ. B.LinS.Y. (2014) Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: A systematic review. Laryngoscope124(3): 616–627.
7.
FalagasM. E.GiannopoulouK. P.VardakasK. Z.DimopoulosG.KarageorgopoulosD. E. (2008) Comparison of antibiotics with placebo for treatment of acute sinusitis: A meta-analysis of randomized controlled trials. The Lancet Infectious Diseases8(9): 543–552. doi: 10.1016/S1473-3099(08)70202-0.
8.
FokkensW. J.LundV. J.MullolJ.BachertC.AlobidI.BaroodyF.WormaldP. J. (2012) European position paper on rhinosinusitis and nasal polyps. Rhinology23: 1–298. doi: 10.4193/Rhino50E2.
9.
GunhanK.UnluH.YuceturkA. V.SonguM. (2011) Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: Effects on quality of life and objective parameters. European Archives of Otorhinolaryngology268(6): 845–850. doi: 10.1007/s00405-101-1462-1.
10.
HadfieldP. J.Rowe-JonesJ. M.MackayI. S. (2000) The prevalence of nasal polyps in adults with cystic fibrosis. Clinical Otolaryngology and Allied Sciences25(1): 19–22. doi: 10.1046/j. 1365-2273.2000.00241.x.
11.
HansenF. S.DjupeslandP. G.FokkensW. J. (2010) Preliminary efficacy of fluticasone delivered by a novel device in recalcitrant chronic rhinosinusitis. Rhinology48(3): 292–299. doi: 10.4193/Rhin09.178.
12.
HastanD.FokkensW. J.BachertC.NewsonR. B.BislimovskaJ.BockelbrinkA.BurneyP. (2011) Chronic rhinosinusitis in Europe—an underestimated disease. A GA2LEN study. Allergy66(9): 1216–1223. doi: 10.1111/j.1398-9995.2011.02646.x.
JonesN. S.StroblA.HollandI. (1997) A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clinical Otolaryngology and Allied Sciences22(1): 47–51. doi: 10.1046/j.1365-2273.1997.00862.x.
15.
JuniperE. F.GuyattG. H.O’ByrneP. M.ViveirosM. (1990) Aqueous beclomethasone diproprionate nasal spray: Regular versus “as required” use in the treatment of seasonal allergic rhinitis. Journal of Allergy and Clinical Immunology86(3 Pt 1): 380–386.
16.
KayaliogluG.OyarO.GovsaF. (2000) Nasal cavity and paranasal sinus bony variations: A computed tomographic study. Rhinology38(3): 108–113.
17.
NasserM.FedoroqiczZ.AljufairiH.McKerrowW. (2010) Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children. Cochrane Database of Systematic Reviews7(7): ), CD006989. doi: 10.1002/14651858.CD006989.pub2.
18.
NgK. H.ChongD.WongC. K.OngH. T.LeeC. Y.LeeB. W.ShekL. P. (2004) Central nervous system side effects of first- and second-generation antihistamines in school children with perennial allergic rhinitis: A randomized, double-blind, placebo-controlled comparative study. Pediatrics113(2): e116–e121.
19.
PynnonenM. A.MukerjiS. S.KimH. M.AdamsM. E.TerrellJ. E. (2007) Nasal saline for chronic sinonasal symptoms: A randomized controlled trial. Archives of Otolaryngology and Head and Neck Surgery133(11): 1115–1120. doi: 10.1001/archotol.133.11.1115.
RevaiK.DobbsL. A.NairS.PatelJ. A.GradyJ. J.ChonmaitreeT. (2007) Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: The effect of age. Pediatrics119(6): e1408–e1412. doi: 10.1542/peds.2006-2881.
22.
RudmikL.HopkinsC.PetersA.SmithT. L.SchlosserR. J.SolerZ. M. (2015) Patient-reported outcome measures for adult chronic rhinosinusitis: A systematic review and quality assessment. The Journal of Allergy and Clinical Immunology136(6): 1532–1540. e1–2. doi: 10.1016/j.jaci.2015.10.012.
23.
SeidmanM. D.GurgelR. K.LinS. Y.SchwartzS. R.BaroodyF. M.BonnerJ. R.NnachetaL. C. (2015) Clinical practice guideline: Allergic rhinitis. Otolaryngology and Head and Neck Surgery152(1 Suppl): S1–S43. doi: 10.1177/0194599814561600.
24.
SimonsF. E.SimonsK. J. (2011) Histamine and H1-antihistamines: Celebrating a century of progress. Journal of Allergy and Clinical Immunology128(6): 1139–1150. e4. doi: 10.1016/j.jaci.2011.09.005.
25.
SlavinR. G. (1988) Sinusitis in adults and its relation to allergic rhinitis, asthma, and nasal polyps. Journal of Allergy and Clinical Immunology82(5 Pt 2): 950–956.
26.
SpectorS. L.WangaardC. H.FarrR. S. (1979) Aspirin and concomitant idiosyncrasies in adult asthmatic patients. The Journal of Allergy and Clinical Immunology64(6 Pt 1): 500–506.
27.
SunY.ZhouB.WangC.HuangQ.ZhangQ.HanY. H.LiY. (2012) Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients. Chinese Medical Journal125(6): 1104–1109.
28.
TomassenP.NewsonR. B.HoffmansR.LotvallJ.CardellL. O.GunnbjornsdottirM.JardvisD. (2011) Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis—a GA(2)LEN study. Allergy66(4): 556–561. doi: 10.1111/j.1398-9995.2010.02503.x.
29.
WalkerS. M.DurhamS. R.TillS. J.RobertsG.CorriganC. J.LeechS. C.NasserS. M. (2011) Immunotherapy for allergic rhinitis. Clinical and Experimental Allergy41. 1177–1200. doi: 10.1111/j.1365-2222.2011.03794.x.
30.
Zalmanovici TrestioreanuA.YapheJ. (2013) Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews12. CD005149. doi: 10.1002/14651858.CD005149.pub4.
