Rhinosinusitis. An overview of current management measures in acute and chronic infection.

Abstract

Rhinosinusitis is a common inflammatory bacterial infection of the paranasal sinuses and nasal cavity. Viral infection is often the inciting event. The ensuing inflammation obstructs the narrow ostiomeatal complex, causing facial pain and pressure, nasal obstruction, congestion, postnasal drainage, and mucopurulence. The exacerbation of symptoms after 5 to 7 days or their persistence for more than 10 days indicates acute rhinosinusitis. Acute infection lasts less than 4 weeks and resolves completely with therapy. Chronic rhinosinusitis is defined as the persistence of symptoms beyond 12 weeks. Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae are the primary respiratory tract pathogens involved in both acute and chronic rhinosinusitis. Management is aimed at controlling the infection and decreasing inflammation. The emergence of bacterial resistance can be avoided by the appropriate use of antibiotics. Antibiotic selection is usually empirical, except when culture is possible, and is directed by the common pathogens and their resistance patterns in a given community. Adjunctive therapies can be beneficial in relieving symptoms.