Chronic rhinosinusitis

Chronic rhinosinusitis affects up to 1 in 10 people. It is generally defined as an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.

Predisposing factors include:

• atopy: hay fever, asthma
• nasal obstruction e.g. Septal deviation or nasal polyps
• recent local infection e.g. Rhinitis or dental extraction
• swimming/diving
• smoking

Features

• facial pain: typically frontal pressure pain which is worse on bending forward
• nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
• nasal obstruction: e.g. 'mouth breathing'
• post-nasal drip: may produce chronic cough

Management of recurrent or chronic sinusitis

• avoid allergen
• intranasal corticosteroids
• nasal irrigation with saline solution

🚩 Red flags symptoms

• unilateral symptoms
• persistent symptoms despite compliance with 3 months of treatment