Information ⬇
- Definition: sinusitis of >12 weeks' duration
- Etiology: commonly associated with bacterial or fungal infection
- Chronic bacterial sinusitis: Impaired mucociliary clearance leads to repeated infections as opposed to one persistent infection.
- - Pts have constant nasal congestion and sinus pressure, with periods of increased severity.
- - Sinus CT can define the extent of disease, detect an underlying anatomic defect or obstructing process, and assess response to treatment.
- - Endoscopy-derived tissue samples for histology and culture should be obtained to guide treatment.
- - Repeated antibiotic courses are required, often for 3-4 weeks at a time. Adjunctive measures include intranasal administration of glucocorticoids, sinus irrigation, and surgical evaluation.
- Chronic fungal sinusitis: a noninvasive disease in immunocompetent hosts, typically due to Aspergillus and dematiaceous molds. Recurrence is common.
- - Mild, indolent disease is usually cured with endoscopic surgery and without antifungal agents.
- - Unilateral disease with a mycetoma (fungus ball) in the sinus is treated with surgery and—if bony erosion has occurred—antifungal agents.
- - Allergic fungal sinusitis, seen in pts with nasal polyps and asthma, presents as pansinusitis and thick, eosinophil-laden mucus with the consistency of peanut butter.
Outline ⬆