Chronic sinusitis refers to ongoing long-term sinus infection-inflammation that often develops secondary to a prolonged/refractory acute sinus infection.
It most commonly affects young to middle-aged adults but can uncommonly also affect children.
Chronic sinusitis is defined clinically as a sinonasal infection lasting more than 12 weeks. Patients may present with symptoms of sinusitis such as nasal obstruction, nasal discharge, facial pain, headache, halitosis, anosmia, etc.
It is worth noting is no definite correlation between symptoms and imaging findings of chronic sinusitis and that endoscopic chronic sinusitis may have no imaging correlation as the mucosa is best appreciated on the former 11.
- paranasal sinus anatomical variants obstructing drainage (see below)
- sinonasal polyposis
- chronic allergy
- chronic infection:
- chronic bacterial sinusitis
- chronic allergic fungal sinusitis
A study was done on 150 patients of chronic rhinosinusitis and found the following anatomical variants 10:
- concha bullosa (30%)
- posterior nasal septal deviations (25%)
- uncinate process variations (25%)
- paradoxical middle turbinate (10%)
- agger nasi cells (10%)
- Haller cells (9%)
A characteristic feature on CT sinuses is sclerotic thickened bone (hyperostosis) involving the sinus wall from a prolonged mucoperiosteal reaction. Intrasinus calcification may be present. The presence of opacification is not a good distinguisher from an acute sinus infection.
Treatment and prognosis
Functional endoscopic sinus surgery (FESS) has revolutionised the approach and treatment of chronic rhinosinusitis. Certain anatomical variations are thought to be predisposing factors for the development of sinus disease and it is necessary for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS 10.
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- inflammatory and infective conditions
- granulomatosis with polyangiitis (Wegener granulomatosis)
- paranasal sinus mucocoele
- silent sinus syndrome
- masses and neoplasms
- fibrous-osseous lesions
- inflammatory and infective conditions