Rhinosinusitis is a common condition, affecting more than one in ten adults. This article will review current management strategies. While multi-factorial in aetiology, odontogenic rhinosinusitis is an important subgroup that is often misdiagnosed and recalcitrant to management. Patients with rhinosinusitis often report facial pain, but when it is severe, and mismatched in severity to other sinonasal symptoms, facial migraine should be suspected. Finally, the risks of implantation in the setting of maxillary sinus mucosal thickening and the need for ENT referral in such cases will be discussed.
CPD/Clinical Relevance: Sinus issues may present to a dentist as dental pain, and dental disease may itself cause sinusitis. With increasing use of cone beam imaging, sinus pathology will be detected frequently in dental practice and this review will help to advise practitioners on current best practice.
Article
Rhinosinusitis is a condition of inflammation of the nose and paranasal sinuses. Rhinosinusitis is divided into acute and chronic forms. In Acute Rhinosinusitis (ARS) symptoms resolve within 12 weeks (although usually within 4 weeks) and often have an infective aetiology, while in Chronic Rhinosinusitis (CRS), symptoms last more than 12 weeks without complete resolution, with multiple potential aetiologies, which may include inflammation, infection and obstruction of sinus ventilation.1
CRS is subcategorized into Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and without nasal polyps (CRSsNP), based on visualization of polyps on rhinoscopy or endoscopy. In a worldwide population study, 10.9% of UK adults reported CRS symptoms.2
Acute rhinosinusitis is usually caused by a viral infection, and is usually self-limiting. NICE guidance3 advocates avoidance of antibiotic prescribing unless symptoms persist for more than 10 days, or if the patient has a high risk of complications, or is systemically very unwell. First choice antibiotics in such cases would be co-amoxiclav or doxycycline. A large number of high quality randomized trials support restricting usage of antibiotics.4
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