Recurrent Rhinosinusitis: Symptoms, Causes, Risk, Diagnosis & Treatment

a. What are the common symptoms of recurrent rhinosinusitis?
Recurrent rhinosinusitis is a condition characterized by multiple episodes of inflammation and infection of the paranasal sinuses, which can cause a range of symptoms. Some of the common symptoms of recurrent rhinosinusitis include:

1. Nasal congestion or blockage: This is one of the most common symptoms of recurrent rhinosinusitis. The inflammation and swelling of the nasal passages and sinuses can cause the nasal passages to become congested, making it difficult to breathe through the nose.
2. Postnasal drip: Another common symptom of recurrent rhinosinusitis is postnasal drip. This occurs when excess mucus produced by the sinuses drains down the back of the throat, causing a sensation of dripping or tickling in the throat.
3. Facial pain or pressure: Recurrent rhinosinusitis can cause pain or pressure in the face, particularly in the area around the eyes, cheeks, and forehead. The pain may be dull or throbbing and may worsen with changes in temperature or barometric pressure.
4. Headache: Many people with recurrent rhinosinusitis experience headaches, which can range from mild to severe. The headaches may be accompanied by facial pain or pressure and may be worsened by bending forward.
5. Loss of sense of smell or taste: Recurrent rhinosinusitis can cause a temporary loss of sense of smell or taste. This is because the inflammation and swelling in the nasal passages can block the smell receptors in the nose, making it difficult to detect odours or taste food.  [3]

b.How do the symptoms of recurrent rhinosinusitis differ from those of acute rhinosinusitis?

Acute rhinosinusitis is a short-term condition characterized by inflammation and infection of the paranasal sinuses. While the symptoms of acute rhinosinusitis and recurrent rhinosinusitis may be similar, there are some differences between the two conditions.

Acute rhinosinusitis typically lasts for less than four weeks, while recurrent rhinosinusitis is characterized by four or more episodes of acute rhinosinusitis per year. The symptoms of acute rhinosinusitis often come on suddenly and can include:

• Thick, discoloured nasal discharge
• Pain or pressure in the face
• Nasal congestion or blockage
• Loss of sense of smell or taste
• Cough
• Fatigue

In contrast, the symptoms of recurrent rhinosinusitis may be less severe than those of acute rhinosinusitis but are more persistent. The symptoms may come and go over time, with periods of remission between episodes. People with recurrent rhinosinusitis may experience more subtle symptoms, such as mild nasal congestion, postnasal drip, and occasional headaches or facial pain. However, these symptoms can have a significant impact on a person's quality of life, especially if they occur frequently or are long-lasting.

a. What are the common causes of recurrent rhinosinusitis?
Recurrent rhinosinusitis, also known as chronic rhinosinusitis, is a condition characterized by inflammation of the nasal cavity and sinuses lasting for more than 12 weeks. Some of the common causes of recurrent rhinosinusitis include:

1. Allergies: Allergic rhinitis, also known as hay fever, can cause inflammation of the nasal cavity and sinuses. This can lead to recurrent episodes of rhinosinusitis.
2. Nasal polyps: Nasal polyps are noncancerous growths that develop in the lining of the nasal cavity or sinuses. They can block the flow of mucus and cause recurrent sinus infections.
3. Deviated septum: A deviated septum is a condition in which the nasal septum, the bone and cartilage that separates the two nostrils, is crooked or off-centre. This can block the sinus openings and lead to recurrent sinus infections.
4. Immune system disorders: Certain immune system disorders, such as HIV/AIDS and common variable immunodeficiency (CVID), can weaken the immune system and make a person more susceptible to recurrent infections.
5. Environmental factors: Exposure to environmental irritants, such as cigarette smoke and air pollution, can irritate the nasal cavity and sinuses and lead to recurrent infections.  [4]

b. Can dental problems cause recurrent rhinosinusitis?
Yes, dental problems can cause recurrent rhinosinusitis. In some cases, an infection in the teeth, such as a dental abscess, can spread to the sinuses and cause sinusitis. This is known as odontogenic sinusitis. The upper molars are particularly close to the maxillary sinuses, and infections in these teeth can easily spread to the sinuses. In addition, dental procedures such as root canal treatments and extractions can sometimes cause sinusitis if the sinus lining is accidentally punctured during the procedure. It is important for dentists and ENT specialists to work together to properly diagnose and treat dental-related sinusitis. In some cases, treatment may involve both dental and medical interventions.

a. What are the risk factors of recurrent rhinosinusitis?

Recurrent rhinosinusitis, also known as chronic rhinosinusitis, can be caused by a variety of factors, including environmental, medical, and genetic factors. Some of the common risk factors associated with recurrent rhinosinusitis include:

1. Allergies: People with allergies, such as hay fever, are at increased risk of developing recurrent rhinosinusitis. Allergies can cause inflammation in the nasal cavity and sinuses, leading to sinus infections.
2. Nasal polyps: People with nasal polyps are at increased risk of developing recurrent rhinosinusitis. Nasal polyps can obstruct the nasal passages and sinuses, leading to chronic inflammation and recurrent sinus infections.
3. Respiratory infections: People who have frequent respiratory infections, such as colds, flu, and pneumonia, are at increased risk of developing recurrent rhinosinusitis. These infections can lead to inflammation of the nasal cavity and sinuses, making them more susceptible to sinus infections.
4. Smoking: People who smoke or are exposed to secondhand smoke are at increased risk of developing recurrent rhinosinusitis. Smoking can irritate the nasal cavity and sinuses, making them more susceptible to infection.
5. Immune system disorders: People with weakened immune systems, such as those with HIV/AIDS, common variable immunodeficiency (CVID), or other immune system disorders, are at increased risk of developing recurrent rhinosinusitis.
6. Environmental factors: Exposure to environmental irritants, such as air pollution, dust, and chemicals, can irritate the nasal cavity and sinuses, leading to chronic inflammation and recurrent sinus infections.
7. Structural abnormalities: People with structural abnormalities in the nasal cavity or sinuses, such as a deviated septum or narrow sinus openings, are at increased risk of developing recurrent rhinosinusitis. These abnormalities can obstruct the nasal passages and sinuses, leading to chronic inflammation and recurrent sinus infections.
8. Genetic factors: There may be a genetic component to recurrent rhinosinusitis, with some people being more predisposed to developing the condition due to inherited traits.  [6]

b. How can it be prevented?

Recurrent rhinosinusitis, also known as chronic rhinosinusitis, can be prevented or minimized by taking the following measures:

1. Avoid allergens: If you have allergies, try to avoid the allergens that trigger your symptoms. This may include avoiding pets, pollen, dust mites, and other environmental allergens.
2. Practice good hygiene: Washing your hands frequently and avoiding close contact with people who are sick can help prevent the spread of respiratory infections, which can lead to rhinosinusitis.
3. Quit smoking: If you smoke, quitting can help reduce your risk of developing rhinosinusitis. Smoking can irritate the nasal cavity and sinuses, making them more susceptible to infection.
4. Use a humidifier: Keeping the air in your home or office moist with a humidifier can help reduce nasal congestion and inflammation, which can help prevent rhinosinusitis.
5. Treat underlying conditions: If you have underlying medical conditions, such as allergies, asthma, or immune system disorders, it's important to work with your healthcare provider to manage these conditions effectively.
6. Maintain good dental health: Good dental health can help prevent dental-related sinus infections, which can lead to rhinosinusitis. Brush and floss your teeth regularly, and see your dentist for regular checkups and cleanings.
7. Manage stress: Stress can weaken the immune system and make you more susceptible to infections. Taking steps to manage stress, such as practising yoga or meditation, getting regular exercise, and getting enough sleep, can help reduce your risk of developing rhinosinusitis.

a. How is recurrent rhinosinusitis diagnosed?

Recurrent rhinosinusitis is typically diagnosed based on a combination of clinical symptoms and imaging studies. Your healthcare provider may ask you about your symptoms, such as nasal congestion, facial pain, headache, postnasal drip, and cough. They may also perform a physical exam, looking for signs of inflammation or swelling in the nasal cavity and sinuses.

Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), may be ordered to confirm the diagnosis and determine the extent and severity of the sinus disease. These imaging studies can help identify structural abnormalities, such as nasal polyps or a deviated septum, which may be contributing to your symptoms.

In some cases, your healthcare provider may perform a nasal endoscopy, which involves inserting a small, flexible scope into your nose to examine the nasal cavity and sinuses. This can help identify areas of inflammation or obstruction and guide treatment decisions.  [8]

b. Are there any specific diagnostic criteria for recurrent rhinosinusitis?

Yes, the American Academy of Otolaryngology-Head and Neck Surgery has established diagnostic criteria for recurrent rhinosinusitis. According to these criteria, a person must have two or more of the following symptoms, each lasting for at least 12 weeks:

• Nasal congestion or obstruction
• Facial pain or pressure
• Nasal discharge or postnasal drip
• Decreased sense of smell or taste

In addition to these symptoms, a person must also have evidence of inflammation in the nasal cavity and sinuses, as confirmed by imaging studies or nasal endoscopy. Finally, a person must have received appropriate medical therapy for their symptoms, such as nasal corticosteroids or antibiotics, with no significant improvement in their symptoms.

If a person meets these diagnostic criteria, they may be diagnosed with recurrent rhinosinusitis and recommended for further evaluation and treatment.

a. What are the treatment options for recurrent rhinosinusitis?

The treatment of recurrent rhinosinusitis depends on the underlying cause and severity of the disease. In general, treatment may involve a combination of medical therapies, such as antibiotics, nasal corticosteroids, and saline irrigation, as well as lifestyle modifications.

Antibiotics may be prescribed for bacterial infections, while nasal corticosteroids can help reduce inflammation and improve symptoms such as nasal congestion and postnasal drip. Saline irrigation, which involves flushing the nasal cavity with salt water, can help remove mucus and debris and improve nasal function.

In some cases, surgery may be recommended, particularly if there are structural abnormalities or if medical therapies have been unsuccessful. Endoscopic sinus surgery can be used to remove obstructions, such as nasal polyps or deviated septums, and to open up the sinuses for improved drainage and ventilation.

b. Can recurrent rhinosinusitis be cured?

While there is no cure for recurrent rhinosinusitis, the condition can be effectively managed with appropriate treatment and ongoing care. Lifestyle modifications, such as avoiding allergens, practicing good hygiene, and managing stress, can help reduce the risk of recurrence.

Medical therapies, such as antibiotics, nasal corticosteroids, and saline irrigation, can help manage symptoms and reduce inflammation. Surgery may be recommended in some cases, particularly if there are structural abnormalities or if medical therapies have been unsuccessful.

In addition to these treatments, ongoing monitoring and follow-up with your healthcare provider are important to ensure that your symptoms are well-controlled and to identify any changes in your condition. By working closely with your healthcare team and following recommended treatment plans, you can effectively manage recurrent rhinosinusitis and improve your quality of life.

When to contact a doctor:

You should contact a doctor if you experience recurrent or persistent symptoms of rhinosinusitis, such as nasal congestion, facial pain, headache, postnasal drip, and cough. Recurrent rhinosinusitis is defined as having two or more episodes of acute sinusitis per year, while chronic rhinosinusitis is defined as having symptoms that last for 12 weeks or longer.

Recurrent rhinosinusitis is a medical condition that involves multiple episodes of inflammation and infection of the paranasal sinuses, which can be caused by various factors such as allergies, structural abnormalities, immune system deficiencies, and certain medical conditions. Its symptoms include nasal congestion or blockage, postnasal drip, facial pain or pressure, headache, and loss of sense of smell or taste. Prevention measures include avoiding triggers such as allergies and practicing good nasal hygiene. Treatment may include antibiotics, antihistamines, nasal corticosteroids, and surgery in severe cases. Recurrent rhinosinusitis can have a significant impact on a person's quality of life, especially if the episodes are frequent or long-lasting. It is important to contact a doctor if experiencing recurrent symptoms of rhinosinusitis to receive appropriate treatment and prevent complications.