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Sinusitis, also referred to as rhinosinusitis, is a common symptomatic inflammation of the nasal cavity and paranasal sinuses. It can occur due to a variety of conditions like allergies, infection, etc., and its symptoms are generally divided into two major categories – major and minor. The infection causes inflammation and irritation of the nasal passages and paranasal sinuses, which reduces the size of sinus openings and obstructs the air and mucus flow through them.
Generally, the etiology behind RARS mirrors other types of sinusitis. It can occur due to allergies and infections from bacteria, viruses, and fungi. Upper respiratory infections due to viruses are normally self-limiting and do not spread beyond the nasal and paranasal areas.
Common bacterial pathogens that can lead to RARS are Streptococcus pneumoniae, Haemophilus influenzae, other Streptococcus species, Moraxella catarrhalis, and Staphylococcus aureus. It can also occur as a post-operative hospital infection due to MRSA (Methicillin-resistant Staphylococcus aureus). Fungal RARS infections can occur due to Aspergillus fumigatus. Other etiological factors include anatomical and environmental factors.
Diagnostic criterion for RARS
The diagnosis for RARS is done on the basis of two criteria – major factors and minor factors. Major diagnostic criteria include the degree of purulence, nasal obstruction, nasal discharge, effect on the sense of smell, fever, facial congestion, pain, and swelling. Minor diagnostic criteria for RARS are ear pain and pressure, cough, dental pain, fatigue, halitosis, fever, and headache.
Physical examination and diagnostic tests
The ENT examination begins with a detailed medical history, in which the surgeon collects info about previous disease episodes and treatments. During the physical examination, the surgeon looks for signs of anatomical deformities and examines the swelling and tenderness in facial tissues. Finally, they may perform several diagnostic tests. Since the presentation of RARS is very similar to acute sinusitis, its diagnostic tests may be similar too:
Nasal and throat tissue cultures: In case of infections, tissue cultures help narrow down the causing organism, which helps manage the infection and prevent its recurrence without surgical intervention.
Risks of untreated recurrent acute sinusitis
You should consult an ENT doctor for treatment if your symptoms are getting worse even after treatment or if you’re experiencing frequent episodes of sinusitis despite following proper preventive and treatment measures. Some complications of untreated acute sinusitis are:
If you’ve recently suffered from sinusitis or are at risk of it, you should follow the given preventive guidelines to prevent its recurrence:
If you get sinus infections even after following these precautions, contact an ENT specialist immediately to avoid acute sinusitis and its complications.
Since the clinical presentation of RARS is very similar to acute sinusitis, its treatment measures are similar as well. Most patients get better with medical management or lifestyle changes, but if they have anatomical deformities that are causing the recurrence of sinusitis, the patient may need surgery for its correction.
Medical management of RARS includes over-the-counter painkillers & anti-inflammatories, oral and nasal decongestants, saline sprays, etc. Surgical intervention includes sinus surgeries like balloon sinuplasty, FESS, and complimentary surgeries like septoplasty, turbinoplasty, turbinoplasty, etc., as needed.