Because the nasal mucosa is simultaneously involved and because sinusitis rarely occurs without concurrent rhinitis, rhinosinusitis is now the preferred term for this condition.
Rhinosinusitis affects an estimated 35 million people per year in the United States and accounts for close to 16 million office visits per year.
To properly diagnose and treat infectious disorders of the paranasal sinuses, the clinician should have knowledge of the developmental milestones.
The development of the paranasal sinuses begins in the third week of gestation and continues until early adulthood.
(See Anatomy, Pathophysiology, and Etiology.) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections.
No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management.
Options for medical drainage are as follows: Sinusitis is characterized by inflammation of the lining of the paranasal sinuses.
Rhinosinusitis may be further classified according to the anatomic site (maxillary, ethmoidal, frontal, sphenoidal), pathogenic organism (viral, bacterial, fungal), presence of complication (orbital, intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants).
(See Treatment and Management.) Most patients with acute sinusitis are treated in the primary care setting.
By the teenage years, each maxillary sinus progressively enlarges to an adult capacity of 15 m L.
In healthy individuals, the ethmoid sinuses increase in number to 18-20, and each drains by an individual ostium that is 1-2 mm in diameter.
The maxillary and ethmoid sinuses form at 3-4 months' gestation.
Thus, an infant is born with 3-4 ethmoid cells and tiny teardrop-shaped maxillary sinuses.
Proliferation of maxilloturbinate mesenchyme between these grooves results in an outpouching of tissue medially into the nasal lumen.