19 January 2021 Author : Jorge Manuel Nascimento Rhinosinusitis, commonly known only as sinusitis, is an i nflammation of the mucosa lining the paranasal sinuses (sinusitis) and the nose (rhinitis). The paranasal sinuses are air-filled spaces located inside the facial bones, on each side of the nasal cavity; They have a lining similar to that of the nasal cavity with which they are connected; The function of the paranasal sinuses is to maintain the resistance and shape of the bones where they are located and to reduce their weight; There are 4 four types of paranasal sinuses: maxillary, ethmoidal, frontal, and sphenoidal. The anatomical relationship between the nasal cavity, the paranasal sinuses, the orbit, and other intracranial structures explains several complications of rhinosinusitis. Rhinosinusitis may also be related with bronchi and lungs disorders worsening, such as asthma, chronic obstructive pulmonary disease, and bronchiectasis. This disease has a very high prevalence , and its symptoms can have a significant impact on quality of life. Causes Rhinosinusitis can have several causes : The common one is a viral infection ; Bacterial rhinosinusitis is usually a complication of viral rhinosinusitis; Another important cause of rhinosinusitis is environmental exposure, often associated with allergies . Symptoms and evolution Rhinosinusitis has several symptoms , the most common are: Difficulty breathing through the nose due to congestion or blockage (stuffy nose); Rhinorrhea (runny nose), which can be anterior (outward through the nose) or posterior (to the throat): Headache; Pain or pressure feeling on the face; Changes in smell. Depending on its evolution , rhinosinusitis can be: Acute , when it does not last more than 4 weeks; Chronic , when it lasts beyond 12 weeks. The development of chronic rhinosinusitis occurs as follows: Initially, secretions related to inflammation and infection of the lining mucosa are produced; Secretions accumulate inside the paranasal sinuses; Communication between the paranasal sinuses and the nasal cavities is obstructed; Aeration is less, the mobilization of secretions to be eliminated is compromised; A favorable environment for bacterial growth is created; A vicious circle of maintenance of the disease develops, with successive aggravations or that continues over time. Chronic rhinosinusitis may or may not be associated with nasal polyps. Diagnosis of chronic rhinosinusitis The diagnosis of rhinosinusitis is based on: Clinical history; Otorhinolaryngological examination performed at the consultation, including anterior rhinoscopy that can be complemented with endoscopic examination; Additional diagnostic tests, for example CT scan of the paranasal sinuses, which can reveal anatomical changes that predispose to the disease. Treatment of chronic rhinosinusitis The main assumptions for normalization in the treatment of chronic sinusitis are the restoration of ventilation and drainage of the paranasal areas, with a normal function of mobilizing secretions. Medical treatment Depending on the specifics of the case, medical treatment may include systemic or topical anti-inflammatories, antihistamines, antibiotics, and nasal showers with saline solutions. Surgical treatment Surgical treatment of chronic sinusitis can be considered when, despite medical treatment: Successive acute crisis continue to occur; Anatomical conditions are present that predispose to obstruction of communications between the paranasal sinuses and the nasal cavity; There is imaging confirmation of the persistence of sinusitis or concomitant diseases. Any surgery is intended to be as less invasive as possible, safeguarding the effective resolution of the disease. Thus, the surgical technique in otorhinolaryngology also evolved from open procedures to endoscopic procedures , with minimal interference in sinus and nasal anatomy and physiology , which became possible following the introduction of nasal endoscopy in the 1980s, and the CT scan of the paranasal sinuses. Among the surgical techniques available, the otorhinolaryngologist, according to his experience and the specifics of each patient and his disease, will therefore advise the least invasive one that will resolve rhinosinusitis. More information on chronic sinusitis surgery : sinuplasty and balloon tuboplasty Meet the otorhinolaryngology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
