AAO-HNSF Primary Care Otolaryngology Handbook

RHINOLOGY, NASAL OBSTRUCTION, AND SINUSITIS

The paranasal sinuses are classified into four paired sets (Figure 8.1): • Frontal sinuses, located above the eyes and nasal cavity • Maxillary sinuses, located under the eyes, lateral to the nasal cavity • Ethmoid sinuses, located between the eyes • Sphenoid sinuses, located behind the eyes in the midline Rhinitis Rhinitis is inflammation of the nasal mucosa. Allergic rhinitis is discussed in detail in Chapter 9. Nonallergic or vasomotor rhinitis can mimic allergic rhinitis. In both cases, patients present with clear rhinorrhea, no other allergic symptoms or history, and allergy tests are negative. Nonallergic rhinitis is often triggered by food, temperature changes, envi- ronmental irritants, hormonal changes, or drugs. Intranasal steroid sprays, antihistamine nasal sprays, anticholinergic nasal sprays, and nasal saline irrigation are often used to treat vasomotor and nonallergic rhinitis. The “Common Cold” Acute viral rhinosinusitis or upper respiratory infection (URI) is frequently attributed to one of a multitude of rhinoviruses, and results in symptoms we refer to as the “common cold.” The pathophysiology involves infection, inflammation, mucosal swelling, and increased mucus production. Low-grade fever, clear or purulent nasal drainage, nasal congestion, sore throat, and cough are common symptoms. Treatment is symptomatic, with analgesics, hydration, decongestants, topical intra- nasal steroids, and nasal saline irrigation recommended, as needed. Symptoms usually peak around day 3 and spontaneous resolution occurs in 7–10 days. Antibiotic treatment of the common cold is discouraged, but unfortunately, patients often request (or demand) antibiotics early in the course of viral illness. When spontaneous recovery occurs, they assume that the antibiotics were responsible. This is a major cause of excessive antibiotic use and has contributed to the surge in antibiotic resistance. Acute Bacterial Rhinosinusitis Prolonged nasal and sinus mucosal edema, most often from a viral URI, may lead to acute bacterial rhinosinusitis . Patients present with purulent nasal drainage (Figure 8.2) accompanied by nasal obstruction and/or facial pressure/pain/fullness . Other symptoms may include anosmia, headache, fever, fatigue, cough, toothache, and ear fullness/pressure. Radiographic studies (plain films or computed tomography (CT) scans) do not differentiate acute bacterial rhinosinusitis from a viral URI; more

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