Recurrent Acute Rhinosinusitis - Causes, Symptoms, Treatment

What is Recurrent Acute Rhinosinusitis (RARS)?

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.

What are the most common causing organisms behind RARS?

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.

Recurrent Sinus Causes

• Allergies
• Infection due to bacteria, fungi, and viruses
• Anatomic obstructive abnormalities like turbinate hypertrophy, conchae bullosa, stenosed sinus ostia, Haller cells, nasal polyposis, nasal masses, and nasal septum deviation
• Genetic factors that affect mucus production
• Smoking, etc.

Recurrent Sinus Symptoms

• Thick and discolored nasal discharge
• Postnasal drip
• Blocked nose
• Pain, swelling, and tenderness on the paranasal areas like cheeks, eyes, forehead
• Sinus headaches
• Fever
• Pain and swelling of the gums
• Reduced sense of smell

Recurrent Sinus Diagnosis

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:

• Imaging tests: CT and MRI scans help diagnose anatomical abnormalities that may be the cause of recurring infections. Patients who’ve had more than 3 or 4 episodes of severe sinusitis should get an imaging scan.
• Nasal endoscopy: A nasal endoscopy helps see nasal passages and paranasal sinuses to diagnose tissue swellings and obstructions that may be behind recurring infections.
• Allergy test: One of the most common reasons behind recurring rhinitis and sinusitis is allergy. They often go undiagnosed for a long time, leading to the worsening or recurrence of sinus infections without proper management and long-term relief.

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 & Complications

Risks factors behind RARS

• Nasal allergies
• Frequent exposure to nasal irritants like smoke, aerosols, etc.
• Cold environments
• Immune system disorders like cystic fibrosis, HIV/AIDS
• Anatomical abnormalities of the breathing passage

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:

• Chronic sinusitis: Chronic sinusitis is a condition in which the symptoms last more than 12 weeks and do not get better overtime even with medical management.
• Spread of the infection: The infection can spread to other parts of the body like brain, skull bones, eye socket, etc., and lead to symptoms associated with that region.
• Difficulty in breathing: Recurring sinus infections over a long period of time can lead to permanent damage to the nasal passages and difficulty in breathing.
• Decreased quality of life: Periodically recurring sinus infections can lead to a diminished quality of life.

Prevention

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 are close to people with upper respiratory infections like cold, flu, etc., then avoid direct contact with them. Wear a mask around them and do not share food or utensils with them.
• Wash your hands frequently, especially before meals. Carry a hand sanitizer with you to maintain hygiene and cleanliness.
• If you are prone to nasal allergies and rhinitis, then avoid allergens and other contaminants, like smoke, dust, exhaust fumes, etc., that can inflame your lungs and airway.
• If you live in dry or arid regions, use a humidifier to moisten the air in your surroundings.

If you get sinus infections even after following these precautions, contact an ENT specialist immediately to avoid acute sinusitis and its complications.

Treatment Overview

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.