| ICD-9-CM: |
| 461 - | Sinusitis, Acute |
| 461.0 - | Maxillary, Acute Antritis |
| 461.1 - | Sinusitis, Frontal |
| 461.2 - | Sinusitis, Ethmoidal |
| 461.3 - | Sinusitis, Sphenoidal |
| 461.8 - | Sinusitis, Acute, Other |
| 461.9 - | Sinusitis, Unspecified |
| 473 - | Chronic Sinusitis |
| 473.0 - | Chronic Sinusitis, Maxillary; Antritis (chronic) |
| 473.1 - | Chronic Sinusitis, Frontal |
| 473.2 - | Chronic Sinusitis; Ethmoidal |
| 473.3 - | Chronic Sinusitis; Sphenoidal |
| 473.8 - | Chronic Sinusitis, Other; Pansinusitis (Chronic) |
| 473.9 - | Sinusitis, Chronic, Unspecified |
| Sinusitis is inflammation of the mucosal lining of one or more sinuses that connect to the nasal passageway. The sinuses comprise four pairs of air-filled chambers above the eyes in the forehead (frontal sinuses), behind the cheekbones (maxillary sinuses), behind the nose (sphenoid sinuses), and between the eyes at the bridge of the nose (ethmoid sinuses).
Sinusitis can be caused by bacterial, fungal, or viral infection. Contributing factors include allergies, abnormal anatomical structure of the sinuses or nose, sinus tract injury, and, more commonly, viral infections of the upper respiratory tract such as the common cold. The sinuses normally produce mucus that is cleared through a self-cleaning mechanism: mucus and particles pass through tiny drainage channels into the nose and throat (nasopharynx) where they are swallowed and eliminated through the intestinal tract. However, when the mucosal lining becomes inflamed, the small drainage openings to the nose become narrowed and/or blocked. Because mucus cannot drain properly, the sinus cavities fill with mucus, causing uncomfortable pressure (sinus headache) and creating an ideal environment for organisms to multiply and cause infection.
Sinusitis may be acute or chronic. Acute sinusitis is a new infection that typically begins with an acute viral infection that can lead to development of bacterial sinus infection in susceptible individuals. Acute sinusitis varies in severity and may last up to 4 weeks; it may recur several times a year. Sinusitis is considered subacute if an infection lasts up to 12 weeks, and subacute sinusitis may transition to chronic sinusitis (infection lasting at least 12 weeks).
Single bacterial organisms usually cause acute sinusitis (e.g., Staphylococcus pneumoniae, H. influenzae and M. catarrhalis). Multiple bacterial organisms are usually responsible for chronic sinusitis, including Staphylococcus aureus and Staphylococcus epidermidis, which are normal bacteria in the nasal passages.
Although bacterial sinusitis most commonly occurs after an upper respiratory tract viral infection, it can also be caused or aggravated by an abscess of an upper tooth, changes in atmospheric pressure (e.g., airplane flights), mold or fungi, and chemical irritation of the sinuses from toxic fumes such as chlorine gas. Allergies may be associated with chronic inflammation, making individuals more susceptible to bacterial infection. Underlying conditions such as immunodeficiency, cystic fibrosis, and inflammatory diseases (e.g., chronic bone inflammation or osteitis) may also predispose an individual to acute or chronic sinusitis.
Immunocompromised individuals, post-operative patients who have had an endotracheal tube passed through the nose, dialysis patients, burn patients, patients with severe trauma, and individuals with uncontrolled diabetes, cystic fibrosis or inflammatory diseases are at greater risk of developing bacterial sinusitis.Risk: Sinusitis can affect individuals of any age and is equally common in men and women. Incidence and Prevalence: Sinusitis affects approximately 16% of the population annually. Sinus inflammation is reported by 30 million adults in the US each year (Orlandi), resulting in 16 million office visits annually (Davidoff). |
Source: Medical Disability Advisor
| History: Acute and chronic sinusitis are diagnosed mainly by reported symptoms. Individuals may report nasal congestion, presence of thick yellow/green discharge from the nose, toothache, sore throat, loss of smell, poor response to nasal decongestants, recent history of a cold or allergic rhinitis, headache (especially upon awakening), and/or facial pain. The headache and facial pain may be located over the infected sinus. Bacterial sinusitis most commonly occurs following a viral infection, and is often associated with symptoms that last longer than 7 to 10 days. A general medical history must include prior or existing conditions, injuries (broken nose, head injuries), surgeries (e.g., tooth extraction) and diseases. It is important to be aware of immunodeficiency, administration of immunosuppressive drugs (chemotherapy), or underlying inflammatory diseases. Physical exam: Physical examination will include a thorough evaluation of respiratory health, including tapping with the fingers (percussion) over the frontal and maxillary sinuses, which may reveal tenderness. A strong light may be directed over the sinuses to observe if fluid is present (transillumination of the sinuses). The nasal passage will be examined for purulent discharge and swollen membranes. Ears will be examined for simultaneous serous otitis or otitis media. The throat will be examined for inflammation and signs of mucopurulent drainage. A stethoscope may be used to rule out lung congestion, especially if a cough is present. Body temperature is measured. Tests: Laboratory tests include a CBC to check for an elevated white blood cell count that may indicate active infection. A nasal smear may be examined for white blood cells, and nasal drainage is usually cultured to identify bacteria that may be causing infection. The absence of specific bacteria may indicate a virus or fungus as the source of infection, which may be confirmed through additional tests. Sinus x-rays, cranial CT, cranial MRI, or nasal endoscopy can confirm sinusitis or thickening of sinus membranes. These tests are not usually done in acute sinusitis, and may be reserved for recurrent or chronic sinusitis. |
Source: Medical Disability Advisor
| The goals of treatment for acute sinusitis and chronic sinusitis flare-ups are to cure the infection, to reduce inflammation, and to alleviate symptoms. Reestablishing normal clearance of mucus is usually done with medications. Decongestants (oral, nose drops, or nasal steroid sprays) may be recommended to shrink nasal and sinus membranes to increase sinus drainage. Antihistamines are used in individuals with underlying allergies. Mucolytic medications or expectorants may be used to thin mucus and facilitate drainage. Over-the-counter analgesics may be used for pain. Increasing fluid intake and using a humidifier will increase moisture in affected sinuses and help thin mucus to increase drainage. Antibiotics are given to treat bacterial infection, typically for 10 to 14 days. On average, adults have two or three colds a year, of which only 0.5% to 2% are complicated by acute bacterial sinusitis, yet antibiotics are prescribed for 50% or more of cases. Broad-spectrum antibiotics are sometimes prescribed for chronic sinusitis, but reducing inflammation with nasal corticosteroids or other anti-inflammatory medications is often the mainstay of treatment, especially in individuals with asthma, allergic rhinitis, or nasal polyps. Long-term treatment for chronic sinusitis relies on anti-inflammatory measures and reserves antibiotics for acute flare-ups only.
If sinusitis is unresponsive to medical therapy and is chronic in nature, surgery may be performed to correct an anatomical defect affecting sinus drainage (e.g., deviated septum), or to clean and drain the sinuses (endoscopic sinus surgery). Endoscopic surgery is performed under local or general anesthesia and is effective in enlarging the natural openings of the sinuses. The most common type of surgery used to treat chronic sinusitis is ethmoidectomy. The small ethmoids sinuses are located between the eyes. An ethmoidectomy removes diseased tissue and bone, creating a larger opening for drainage. An ethmoidectomy is usually performed with an endoscope. Finally, a turbinectomy may be performed to shrink swollen membranes in the nasal cavity. This procedure takes a few minutes and is performed in a doctor's office. |
Source: Medical Disability Advisor
| Individuals with uncomplicated acute sinusitis can expect a full recovery and return to work. Approximately 70% of acute bacterial sinusitis resolves spontaneously without antibiotics, the use of antibiotics increasing this percentage of recovery to 85% (Orlandi). Rarely, sinusitis complicated by spread of infection to facial bones or brain will extend treatment times and require a more lengthy recovery. Fungal sinusitis is rare but can spread rapidly and result in death in immunocompromised individuals (e.g., cancer patients, HIV/AIDS patients, or in uncontrolled diabetes or dialysis patients).
Chronic sinusitis varies in acuity among individuals but requires ongoing long-term treatment for inflammation and periodic treatment for acute flare-ups. Individuals with no significant underlying illnesses may recover completely. Individuals with inflammatory illnesses, compromised immune systems, or allergic conditions are subject to episodes of acute bacterial sinusitis.
Individuals requiring sinus surgery can expect to return to normal activities within 5 to 7 days postoperatively and to achieve full recovery in approximately 4 to 6 weeks.
Treatment fails in approximately 10% to 25% of patients (Davidoff). |
Source: Medical Disability Advisor
| The incidence of complications from acute sinusitis is low, with or without use of antibiotics. The persistence of bacteria in the sinuses rarely leads to chronic sinusitis, but persistent inflammation will increase the likelihood of a chronic condition and complications such as spread of infection to the bones of the face (osteomyelitis), the soft tissue of the face (cellulitis), or the brain (brain abscess, or rarely meningitis). Other possible complications include abscess formation and blood clot formation in the cavernous sinus (cavernous sinus thrombosis).
Spread of infection to the eyes, mouth, and brain occurs more often in individuals with depressed immunity from HIV/AIDS or chemotherapy. Individuals with chronic sinusitis who experience recurrent and prolonged bacterial sinus infections may require surgery to permanently improve sinus drainage. |
Source: Medical Disability Advisor
| During the duration of a sinus infection, it is important that the individual have access to adequate amounts of fluids. The individual should avoid irritating fumes and smoke, or wear a protective mask. Special air filters called high-efficiency particulate filters and electrostatic filters may be helpful to reduce environmental pollutants. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a clinical history of a cold or rhinitis?
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Have respiratory tract symptoms been present for 7 to 10 days or longer?
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Does individual have symptoms suggestive of sinusitis (headache, facial pain, upper tooth ache, or purulent nasal discharge)?
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Were the findings on the clinical exam consistent with the diagnosis of sinusitis?
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Was a nasal culture done?
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If the diagnosis was uncertain, were conditions with similar symptoms such as allergy or infected teeth ruled out?
Regarding treatment:
- Was the treatment appropriate for the diagnosis?
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Were symptoms relieved?
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Were appropriate antibiotics administered, as indicated?
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Was surgical intervention needed?
Regarding prognosis:
- Did the individual have surgery? An adenoidectomy? A turbinectomy?
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Did individual have a full recovery?
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Did individual suffer any complications that may have impacted recovery and prognosis?
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Are there any underlying conditions that may lengthen recovery?
|
Source: Medical Disability Advisor
| Davidoff, Tracey Quail, Michael Cunningham, and Ethan Serbetci. "Sinusitis, Acute." eMedicine. Eds. Thomas Herchline, et al. 17 May. 2004. Medscape. 5 Jan. 2005 <http://emedicine.com/med/topic2555.htm>.Orlandi, Richard R. "Sinusitis." Conn's Current Therapy 2007. Ed. Robert E. Rakel. 59th ed. Philadelphia: Saunders, 2007. |
Source: Medical Disability Advisor
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