What is catarrhal rhinosinusitis and how to treat it?

Inflammation of the mucous membrane of the nasal cavity and paranasal (perinasal) sinuses (cavities), accompanied by an accumulation of mucus in them, can be defined as catarrhal rhinosinusitis.

International experts in otolaryngology have adopted the term "rhinosinusitis" on the basis that inflammation of the paranasal sinuses - sinusitis - is usually preceded by infection of the nasal mucosa (rhinitis), since the mucous membranes of the paranasal sinuses and the nasal cavity form a functional unit.

Currently, the definitions of "rhinosinusitis" and "sinusitis" are used interchangeably, and there is not yet a separate code for rhinosinusitis in ICD-10. [1]

Epidemiology

Rhinosinusitis/sinusitis is considered one of the most common diseases in the world, affecting patients of all ages.

Experts at the Infectious Diseases Society of America (IDSA) estimate the annual prevalence of acute rhinosinusitis among Americans at 6-15% and chronic rhinosinusitis at nearly 12%. [2]

Causes What is catarrhal rhinosinusitis and how to treat it?

Catarrhal acute sinusitis/rhinosinusitis is a common disease, the causes of which are related to infection: viral or bacterial. Among the viruses that cause this disease, rhinoviruses, influenza and parainfluenza viruses, adenoviruses, respiratory syncytial virus, etc. Are noted.

Bacteria involved in the development of inflammation include Streptococcus pneumoniae and Haemophilus influenzae, as well as Staphylococcus aureus, Pseudomonas aeruginosa, Moxarella catarrhalis, and Klebsiella aerogenes.

And fungal rhinosinusitis, which is considered allergic fungal rhinosinusitis, can be caused by mold fungi of the families Dematiaceae and Pleosporaceae (Aspergillus fumigatus, Bipolaris, Mucorales, Rhizopus, Curvularia, Alternaria alternata, Absidia, etc.).

In addition, catarrhal rhinosinusitis can be caused by pollen allergy (pollinosis) and frequent allergic rhinitis. [3]

Also see. - What causes sinusitis?

Rhinosinusitis/sinusitis, including those of a catarrhal nature, are divided according to localization into:

• maxillary sinusitis (inflammation of the maxillary or maxillary sinus - sinus maxillaris), i.e. acute maxillary sinusitis (maxillary sinusitis);
• Frontal sinusitis - inflammation of the mucous membrane of the frontal sinus (sinus frontalis) - acute frontitis;
• Acute sphenoidal sinusitis (rhinosinusitis) is an inflammation of the cuneiform sinus (sinus sphenoidalis);
• Lattice sinusitis - acute inflammation of the lattice labyrinth (acute rhinoethmoiditis) or acute anterior ethmoidal rhinosinusitis.

Inflammation of several or all of the sinuses is called pansinusitis.

Risk factors

Risk factors for catarrhal rhinosinusitis/sinusitis include:

• frequent colds and respiratory illnesses;
• enlarged and infected adenoids;
• weakened immune system with increased susceptibility to infections;
• infected carious teeth (and in such cases rhinosinusitis is called odontogenic);
• chronic catarrhal rhinitis;
• adenovirus pharyngitis;
• Respiratory Allergies;
• the presence of polyps in the nasal cavity;
• deviated nasal septum;
• ENT lesions in Wegener's granulomatosis.

Pathogenesis

The main mechanism of development of acute bacterial or viral rhinosinusitis of catarrhal nature is a violation of the ciliary function of the nasal cavity epithelium and mucus transport - mucociliary clearance, which can lead to the accumulation of mucus in the paranasal sinuses.

Read more about pathogenesis in the publications:

• Diseases of the paranasal sinuses
• Acute sinusitis - causes and pathogenesis

Symptoms What is catarrhal rhinosinusitis and how to treat it?

In the case of a viral etiology of catarrhal rhinosinusitis/sinusitis, the first signs are manifested by watery nasal discharge, while acute catarrhal rhinosinusitis caused by bacterial infection causes thicker discharge (yellowish-greenish), headache and fever.

In the next stage symptoms of acute sinusitis include nasal congestion with difficulty breathing through the nose; decreased taste and smell; facial pain, pain in the ears, jaw, and upper teeth; and a feeling of pressure in the facial part of the skull. Swelling around the eyes, swelling of the tissues of the nose and forehead is manifested by edematous catarrhal rhinosinusitis. [4]

Bilateral catarrhal rhinosinusitis/sinusitis is characterized by swelling and pain on both sides.

In chronic maxillary sinusitis/rhinosinusitis - chronic maxillary sinusitis - there is an increase in body temperature, general malaise and weakness, and pain may be felt in the bridge of the nose, above the eyebrows, and in the temples.

If inflammation involves the mucous membrane of the frontal sinus (frontal rhinosinusitis) and in cases of acute anterior ethmoidal rhinosinusitis (ethmoiditis), soreness, pulsating pain and a feeling of distention occur in the forehead, nose and inside one or both eyes (with hyperemia, swelling, limited mobility and increased sensitivity to light). When the cuneiform sinuses are involved, dull throbbing headaches irradiate to the back of the head and may be aggravated by bending over.

The symptoms of chronic rhinosinusitis are less pronounced than in the acute form of the disease. [5]

Complications and consequences

Inflammatory diseases of the paranasal cavities - maxillary sinusitis (maxillary sinusitis), frontal, wedge, acute ethmoidal sinusitis - can produce complications and have serious complications, among others:

• Inflammation of the soft and webbed membranes of the brain - meningitis or encephalitis;
• spread of infection beyond the nasal and perinasal cavities with the development of rhinogenic brain abscesses;
• thrombophlebitis of the dura mater;
• orbital cellulitis;
• inflammation of the tear ducts;
• cranial nerve palsy;
• Osteomyelitis.

Diagnostics What is catarrhal rhinosinusitis and how to treat it?

After history taking, a physical examination and endoscopy (examination) of the nasal cavity is performed.

Laboratory tests are necessary: blood tests (general, COE, HIV and IgE levels); bacterial examination of the pharynx and nasal cavity - nasal mucus analysis.

Diagnosis requires visualization, for which instrumental diagnostics is performed: X-ray of the nasal cavity and paranasal sinuses, CT-study of the nasal cavity and sinuses, endoscopy of the maxillary sinus, etc.

Also read - Examination of the anterior and posterior paranasal sinuses

Differential diagnosis

The differential diagnosis of catarrhal rhinosinusitis includes acute respiratory viral infection, allergic rhinitis, pneumonia, asthma, nasal foreign bodies and tumors, and immunodeficiency (shared with HIV).

Read more - Acute Sinusitis -Diagnosis

Treatment What is catarrhal rhinosinusitis and how to treat it?

For the treatment of catarrhal rhinosinusitis, nasal decongestants (nasal drops) or sprays are used to reduce local edema of the mucosa; analgesics - pain-relieving drugs; local steroids (in the form of intranasal sprays) and phytotherapeutic agents. In the case of bacterial rhinosinusitis, systemic antibiotics are prescribed. Everything is discussed in detail in publications:

• Acute sinusitis - Treatment
• Antibiotics for sinusitis
• How is acute sinusitis treated?
• Sinusitis treatment
• Runny nose and maxillary sinusitis: how to treat it correctly?
• Drops for maxillary sinusitis
• Sprays for maxillary sinusitis
• Nasal rinses
• Nasal irrigation with salt

In the therapy of catarrhal rhinosinusitis of allergic origin, antihistamines are used. [6]

Physiotherapy treatment is used:

• Physiotherapy for rhinitis
• Physiotherapy for maxillary sinusitis
• Inhalation for a runny nose at home

Endoscopic surgical treatment is performed only in chronic rhinosinusitis, if the symptoms cannot be controlled by medication and physiotherapy, and if there is a risk of intracranial complications. The type of surgical intervention (removal of damaged tissue, widening of the nasal passages, correction of anatomical anomalies) is selected on an individual basis. For example, see - Surgical treatment of chronic frontitis

Prevention

The main thing in preventing inflammation of the mucous membranes of the perinasal cavities - do not run acute rhinitis (acute runny nose) to a chronic state and treat it properly. And, if possible, strengthen immunity, including by adhering to a healthy lifestyle.

Forecast

When inflammation of the mucous membrane of the nasal cavity and paranasal sinuses, the prognosis of its outcome depends directly on the severity of the pathological process, its localization, the adequacy of therapy and the presence of complications. Do not delay with a visit to the doctor: catarrhal rhinosinusitis is successfully treated.