*1.1.3 Recurrent acute sinusitis*

It happens several times per year. Four or more episodes of acute sinusitis for 7 days in 1 year of period.

#### *1.1.4 Chronic sinusitis*

Persistent symptoms of sinusitis for 12 weeks or longer [1].

#### **1.2 Etiology, prevalence and epidemiology**

Sinusitis is the inflammation of facial sinuses. Different factors may contribute in sinusitis. Sinusitis may develop by the combination of environmental and host factors. Acute sinusitis is more common in occurrence as compared to chronic sinusitis. High prevalence of sinusitis is in the Midwest, south and among women. Sinusitis more often affects children younger than 15 years of age and adults 25–64 years of age. Common cause of sinusitis is viruses and mostly they are selflimiting. About 90% of the population who get cold also have viral sinusitis. Not only patients suffering with cold have sinusitis elements but atopic patients may also develop sinusitis. Risk factors causing sinusitis are viruses, bacteria, fungi, allergens, irritants (dander, polluted air, smoke, dust mites) [2].

Other risk factors for sinusitis may involve: anatomic defects such as septal deviations, polyps, conchae bullosa, other trauma and fractures involving the sinuses or the facial area surrounding them. Rhinitis medicamentosa, toxic rhinitis, nasal cocaine abuse, barotrauma, foreign bodies. Patients with nasogastric or nasotracheal tubes. Body positioning, intensive care unit (ICU) patients due to prolonged supine positioning that compromises muco-ciliary clearance. Impaired mucous transport from diseases such as cystic fibrosis, ciliary dyskinesia. Immunodeficiency from chemotherapy, HIV, diabetes mellitus, etc. Prolonged oxygen use due to drying of mucosal lining [3].

#### **1.3 Histopathology**

Histopathology is the examination of pathological condition of tissues. Histopathology of respiratory track reveals incidents 1% of viruses, 3% *Streptococcus pneumoniae*, 6% anaerobes, 2% *Streptococcus pyogenes*, 2% *Moraxella*, 21% *Haemophilus influenza* 21%, anaerobes and 4% *Staphylococcus aureus*. In case of chronic sinusitis 20% *S. aureus*, 20%, 4% *S. pneumoniae*, 3% anaerobes, 16% multiple organisms. About 2–7% are fungal incidences in which most common is Aspergillus seen in immunocompromised patients [4].

#### **1.4 Pathophysiology of sinusitis**

There are four sinuses in the facial area around the nose i.e. frontal sinus, maxillary sinus, sphenoid sinus and ethmoid sinus. Most commonly sinusitis develops by the attack of viruses on the upper respiratory track followed by edema and inflammation of nasal lining. This inflammation leads to thick mucus production that obstructs the paranasal sinuses due to which immunity is disturbed and bacterial infection appear at once. Allergic rhinitis may proceed in to sinusitis due to ostial obstruction. Cilia get immobilized due to heavy nasal mucous discharge which further block the drainage. That give the opportunity to the bacteria to enter into sinuses by coughing or by nose blowing. Bacterial sinusitis develop after the viral attack on the upper respiratory track, symptoms of sino nasal disease may get worse in 5 days or become persistent in 10 days [5].

#### **1.5 Clinical presentation of symptoms**

Major symptoms shown by sinusitis patients are pain or pressure on face, nasal obstruction, hyposmia, nasal and post nasal purulence, facial congestion and

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thrombosis [11].

*Sinusitis, Asthma and Headache*

examination.

culture and biopsy [9].

**1.8 Differential diagnosis**

**1.9 Malignancy of sinusitis**

also madly mistaken as sinusitis [10].

eter to confirm the sinusitis [8].

**1.7 Evaluation of lab findings**

*DOI: http://dx.doi.org/10.5772/intechopen.90210*

**1.6 Physical examination and lab findings**

fullness, fever. Minor symptoms of sino nasal disease include malaise, headache,

• Physical examination include looking for the facial swelling, looking for the periorbital edema, post nasal drip, cervical adenopathy and pharyngitis.

• Anterior rhinoscopy shows mucous crusting, obstructive polyps, mucosal

• Five important predicators of sinusitis include 1. Abnormal sinus transillumination, 2. Maxillary dental pain, 3. Colored nasal discharge, 4. Poor response to nasal decongestants and anti-histamines, 5. Mucopurulent seen on

Overall examination of the patient is more valid then to observe single param-

For the acute sinusitis no laboratory tests are recommended in emergency departments because for the acute sinusitis diagnosis is clinically. For the diagnosis of maxillary, frontal, sphenoid sinusitis plain sinus X-ray is most accurate. In contrast plain X-ray is not suitable for the evaluation of ostiomeatal complex or anterior ethmoid cells, which are the originating cell for sino nasal diseases. Positive lab test on plain films for sinusitis shows air-fluid levels, mucosal thickening of 6 mm or even more, sinus opacity. The choice of diagnostic test for sinusitis is the coronal CT at a thickness of 3–4 mm. Clinical findings of CT are sinus wall displacement, air-fluid levels, sinus opacification, 4 mm or more mucosal thickening. For the chronic bacterial and fungal sinusitis choice of diagnostic test is

Most of the time rhinitis or upper respiratory tract infection are mistakenly diagnose as sinusitis. Maxillary toothache can also be mistaken as pain appeared in maxillary sinusitis. Besides this vascular headache, tension headache, epidural abscesses, brain abscesses, subdural empyema, meningitis and foreign bodies are

Sinusitis may spread to the soft tissues of eye orbits, face and bones. Due to the malignancy periorbital cellulitis, facial cellulitis, blindness and orbital abscess may develop. Sinusitis can breach into the brain and cause intra cranial disorders such as meningitis, epidural or subdural empyema and cavernous sinus

Physical examination is performed after the topical decongestant.

cough, dental pain, headache, halitosis, otalgia, fatigue [6, 7].

edema, frank purulence and other anatomical defects.

• Press the forehead and cheeks for deep tenderness.

• Transillumination of the sinuses are also performed.

*Sino-Nasal and Olfactory System Disorders*

**1.2 Etiology, prevalence and epidemiology**

oxygen use due to drying of mucosal lining [3].

Aspergillus seen in immunocompromised patients [4].

**1.4 Pathophysiology of sinusitis**

in 5 days or become persistent in 10 days [5].

**1.5 Clinical presentation of symptoms**

**1.3 Histopathology**

Persistent symptoms of sinusitis for 12 weeks or longer [1].

allergens, irritants (dander, polluted air, smoke, dust mites) [2].

Sinusitis is the inflammation of facial sinuses. Different factors may contribute in sinusitis. Sinusitis may develop by the combination of environmental and host factors. Acute sinusitis is more common in occurrence as compared to chronic sinusitis. High prevalence of sinusitis is in the Midwest, south and among women. Sinusitis more often affects children younger than 15 years of age and adults 25–64 years of age. Common cause of sinusitis is viruses and mostly they are selflimiting. About 90% of the population who get cold also have viral sinusitis. Not only patients suffering with cold have sinusitis elements but atopic patients may also develop sinusitis. Risk factors causing sinusitis are viruses, bacteria, fungi,

Other risk factors for sinusitis may involve: anatomic defects such as septal deviations, polyps, conchae bullosa, other trauma and fractures involving the sinuses or the facial area surrounding them. Rhinitis medicamentosa, toxic rhinitis, nasal cocaine abuse, barotrauma, foreign bodies. Patients with nasogastric or nasotracheal tubes. Body positioning, intensive care unit (ICU) patients due to prolonged supine positioning that compromises muco-ciliary clearance. Impaired mucous transport from diseases such as cystic fibrosis, ciliary dyskinesia. Immunodeficiency from chemotherapy, HIV, diabetes mellitus, etc. Prolonged

Histopathology is the examination of pathological condition of tissues. Histopathology of respiratory track reveals incidents 1% of viruses, 3% *Streptococcus* 

There are four sinuses in the facial area around the nose i.e. frontal sinus, maxillary sinus, sphenoid sinus and ethmoid sinus. Most commonly sinusitis develops by the attack of viruses on the upper respiratory track followed by edema and inflammation of nasal lining. This inflammation leads to thick mucus production that obstructs the paranasal sinuses due to which immunity is disturbed and bacterial infection appear at once. Allergic rhinitis may proceed in to sinusitis due to ostial obstruction. Cilia get immobilized due to heavy nasal mucous discharge which further block the drainage. That give the opportunity to the bacteria to enter into sinuses by coughing or by nose blowing. Bacterial sinusitis develop after the viral attack on the upper respiratory track, symptoms of sino nasal disease may get worse

Major symptoms shown by sinusitis patients are pain or pressure on face, nasal

obstruction, hyposmia, nasal and post nasal purulence, facial congestion and

*pneumoniae*, 6% anaerobes, 2% *Streptococcus pyogenes*, 2% *Moraxella*, 21% *Haemophilus influenza* 21%, anaerobes and 4% *Staphylococcus aureus*. In case of chronic sinusitis 20% *S. aureus*, 20%, 4% *S. pneumoniae*, 3% anaerobes, 16% multiple organisms. About 2–7% are fungal incidences in which most common is

*1.1.4 Chronic sinusitis*

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fullness, fever. Minor symptoms of sino nasal disease include malaise, headache, cough, dental pain, headache, halitosis, otalgia, fatigue [6, 7].
