Aetiology
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Richtlijn acute rinosinusitisPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2023Guide de pratique clinique rhinosinusite aiguëPublished by: Groupe de travail Développement de recommandations de première ligneLast published: 2023The most common cause of acute rhinosinusitis is a viral infection.[10] It is considered uncommon for viral rhinosinusitis to progress to acute bacterial rhinosinusitis, but the exact prevalence of acute bacterial rhinosinusitis is unknown.[11] In one systematic review, about half of patients with suspected acute bacterial rhinosinusitis had positive cultures.[11] The most common bacteria include Streptococcus pneumoniae (up to 35% of cases), Haemophilus influenzae (up to 40% of cases), Moraxella catarrhalis (up to 20% of cases), and beta-haemolytic streptococci such as S pyogenes (up to 8% of cases).[12]
Although the bacterial pathogens have not changed over time, their antibiotic-resistance patterns have altered.[13] Antibiotic resistance depends on the geographic location; therefore, an understanding of local antibiotic resistance patterns is important.[1][2][13]
Although the majority of acute rhinosinusitis infections are from viral infection, antibiotics are often prescribed for suspected bacterial infection. However, this is inappropriate for viral upper respiratory infections, rhinitis, or bronchitis.[14][15]
Pathophysiology
Acute rhinosinusitis is most likely to be caused by the interaction of a predisposing condition (such as environmental triggers), a viral infection, and a consequent inflammatory response within the sinonasal mucosa.[16] With increased oedema and mucus production, the sinus ostium is obstructed, blocking normal ventilation and drainage of the sinus. With decreased mucociliary clearance, stasis of secretions occurs and a secondary bacterial infection can take place. From an inflammatory standpoint, high levels of tumour necrosis factor-beta and interferon-gamma are associated with release of various pro-inflammatory cytokines.
Classification
Types of rhinosinusitis
Duration of symptoms:[1]
Acute: ≤4 weeks or less
Subacute: 4-12 weeks
Chronic: ≥12 weeks
Recurrent acute: ≥4 episodes per year.
Severity:[3]
Characterised according to the presence of fever with purulent nasal discharge, moderate to severe facial or dental pain, or periorbital swelling lasting for at least 3-4 days.
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