II. Definition

  1. Persistent symptoms despite 2 months treatment

III. Etiology

  1. Results from repeated cases of Acute Sinusitis
  2. Mucus membrane loses normal function
  3. Mixed Bacterial flora
    1. Staphylococcus aureus
    2. HaemophilusInfluenzae
    3. Anaerobes (ID)
  4. Fungal organisms in immunocompromised patients
  5. Inadequately treated Allergic Rhinitis
  6. Allergic Fungal Sinusitis

IV. Imaging

V. Management

  1. First-Line
    1. Intranasal Corticosteroids for 8-12 weeks
    2. High volume Nasal Saline irrigation (e.g. Neti Pot) three times daily
      1. Precede each dose of Intranasal Corticosteroid with saline irrigation
  2. Second-line: Systemic Corticosteroids
    1. Indicated for Nasal Polyps or more severe symptoms
    2. Oral Corticosteroid short course
  3. Third-line: Antibiotics
    1. Indicated for signs of acute on Chronic Sinusitis (e.g. fever) or if not improved in 8-12 weeks
    2. Amoxicillin-Clavulanate (Augmentin) for 2 weeks
    3. Doxycycline for 3 weeks (for antiinflammatory effects)
  4. References
    1. Rudmick (2015) JAMA 314(9):926-39 +PMID:26325561 [PubMed]

VI. Management: Refractory cases

  1. Surgery
    1. Septaplasty with or without turbinate reduction
    2. Endoscopic performed outpatient
      1. Removal of anatomic sinus block
      2. Improves symptoms in 85%
  2. Allergy Consultation
  3. Consider Immunologic work-up

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Ontology: Chronic sinusitis (C0149516)

Definition (NCI) Inflammation of the paranasal sinuses that typically lasts beyond eight weeks. It is caused by infections, allergies, and the presence of sinus polyps or deviated septum. Signs and symptoms include headache, nasal discharge, swelling in the face, dizziness, and breathing difficulties.
Concepts Disease or Syndrome (T047)
ICD9 473.9, 473
ICD10 J32 , J32.9
SnomedCT 155525007, 195792008, 266384001, 155528009, 40055000
English Unspecified sinusitis (chronic), Chronic sinusitis, unspecified, chronic sinusitis, chronic sinusitis (diagnosis), Sinusitis chronic NOS, Sinusitis (chronic) NOS, chronics sinusitis, sinus infection chronic, Sinusitis;chronic, chronic infection sinus, chronic rhinosinusitis, chronic sinus infection, chronic infections sinus, sinusitis chronic, Sinusitis, chronic, Chronic sinusitis NOS (disorder), Chronic sinusitis, Chronic infection of sinus, Chronic rhinosinusitis, Chronic sinusitis (disorder), Chronic infection of sinus, NOS, Chronic sinusitis, NOS, Chronic Sinusitis, Chronic sinusitis NOS, Chronic unspecified sinusitis
Italian Sinusite cronica, Sinusite non specificata (cronica), Sinusite cronica NAS
Dutch chronische sinusitis, niet-gespecificeerd, sinusitis chronisch NAO, niet-gespecificeerde sinusitis (chronisch), Chronische sinusitis, niet gespecificeerd, chronische sinusitis, Chronische sinusitis
French Sinusite non précisée (chronique), Sinusite chronique non précisée, Sinusite chronique SAI, Sinusite chronique
German Sinusitis chronisch NNB, chronische Sinusitis, unspezifisch, unspezifische Sinusitis, chronisch, Chronische Sinusitis, nicht naeher bezeichnet, Chronische Sinusitis, chronische Sinusitis
Portuguese Sinusite crónica NE, Sinusite (crónica) NE, Sinusite crónica
Spanish Sinusitis crónica NEOM, Sinusitis crónica no especificada, Sinusitis no especificada (crónica), sinusitis crónica, SAI, sinusitis crónica, SAI (trastorno), sinusitis crónica (trastorno), sinusitis crónica, Sinusitis crónica
Japanese 慢性副鼻腔炎, 慢性副鼻腔炎NOS, 詳細不明の副鼻腔炎(慢性), 慢性副鼻腔炎、詳細不明, マンセイフクビクウエンショウサイフメイ, ショウサイフメイノフクビクウエンマンセイ, マンセイフクビクウエン, マンセイフクビクウエンNOS
Czech Chronická sinusitida, Blíže neurčená sinusitida (chronická), Chronická sinusitida, blíže neurčená, Chronická sinusitida NOS
Korean 만성 굴염, 상세불명의 만성 굴염
Hungarian Nem meghatározott sinusitis (chronicus), chronicus sinusitis, Sinusitis chronica k.m.n., chronicus sinusitis, nem meghatározott