One of the 10 most common diagnoses in ambulatory practice is “Acute Rhinosinusitis” AKA “Sinusitis”. Interestingly, it is the fifth most common diagnosis for which antibiotics are prescribed. 1, 2 Most people know about “sinus pain”, and a great deal take over the counter medications to try to treat “sinus pain”. In my short career, I have come across a fair bit of interesting explanations of what and where the sinuses actually are. Some people think it’s attached to the brain while others feel that it’s just within the nasal passage.
The above picture notes the three sinuses we usually look for, including the frontal, ethmoidal, sphenoidal and maxillary sinuses. Commonly, rhinitis (inflammation of the nasal passages) and sinusitis (inflammation of the sinus cavity) are affected at the same time and as such, the more preferable naming is rhinosinusitis.
Most commonly the sinuses affected are maxillary and ethmoidal and having isolated frontal or sphenoidal sinus is quite rare. It should be noted that 90% of upper respiratory infections are accompanied by viral rhinosinusitis.
The great majority (98-99.5%) of patients do not get bacterial superinfections, which is why many times sinusitis does not require the use of antibiotics. There are many guidelines regarding this and is the main reason there are more physicians recommending against the use antibiotics for uncomplicated, mild-moderate rhinosinusitis. 2
Most common causes of rhinosinusitis include:
1. Viral sources (Most common) – rhinovirus, coronavirus, influenza A and B, parainfluenza, respiratory syncytial virus, adenovirus and enterovirus.
2. Bacterial source – Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
3. Allergens
4. Local Irritants
drjvarughese 