ENT (Otorhinolaryngology) · MU Sofia

21. Acute rhinosinusitis. Allergic rhinitis.

Covers acute rhinosinusitis, from its viral and bacterial causes and pathogenesis through its duration and aetiology classification, symptoms, bacterial warning features, examination, imaging, treatment and orbital, intracranial and bony complications. It then turns to allergic rhinitis, covering IgE-mediated early and late phase reactions, severity and duration classes, the allergic triad and associated signs, testing, treatment ladder with immunotherapy, and comorbidities. Differential diagnoses for both conditions are compared throughout.

Inside: 14 sections · 5 labelled pictures · 16 flashcards · 9 min

Topic 21 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 11 sections, about 1,310 words (9 min of reading), with 16 flashcards.

In this note

  1. Acute Rhinosinusitis. Allergic Rhinitis,
  2. Clinical Picture Major Symptoms
  3. Paraclinical and Radiological Examinations
  4. Treatment Options
  5. Possible Complications - often from the spread of infection through the thin bone walls of the ethmoid/frontal sinuses:
  6. Differential Diagnosis
  7. Allergic Rhinitis (AR)
  8. Etiopathogenesis
  9. Classification
  10. Clinical Picture
  11. Possible Complications

Acute Rhinosinusitis. Allergic Rhinitis,

1. Acute Rhinosinusitis (ARS)

1. Definition: Acute Rhinosinusitis (ARS), commonly called acute sinusitis, is the symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than 12 weeks. usually following a viral upper respiratory tract infection.

2. Etiopathogenesis The primary mechanism is obstruction of the sinus ostia (outflow tracts), leading to impaired mucociliary clearance, retention of secretions, and a favorable environment for pathogen growth.

  • Viral (Most Common): Accounts for 90-98% of cases. Typically follows a common cold caused by Rhinovirus, Influenza, or Adenovirus.
  • Bacterial (Secondary): Accounts for 0.5-2% when viral inflammation persists and leads to bacterial superinfection.
  • Common Organisms: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
  • Fungal: Rare in immunocompetent patients; more aggressive in immunocompromised hosts.
  • Other: Odontogenic (dental) infections, barotrauma, chemical irritants.

Pathogenesis

  1. 1. Viral infection → nasal mucosal edema → obstruction of ostiomeatal complex
  2. 2. Impaired sinus ventilation and mucociliary clearance (viral/bacterial toxins impair the movement of the cilia)
  3. 3. Hypoxia and Stasis: Oxygen absorbed by sinus mucosa → creating a vacuum → stagnant secretions become hypoxic → proliferation of anaerobic bacteria → secondary bacterial infection
  • Mucus retention
  • Secondary bacterial infection

3. Classification

A. By Duration

  • Acute: < 4 weeks
  • Subacute: 4–12 weeks
  • Chronic: > 12 weeks
  • Recurrent ARS (RARS): > 4 episodes of ARS per year, with complete symptom resolution between episodes

B. By Etiology

  • Viral acute rhinosinusitis (VRS) (most common): Symptoms present < 10 days and not worsening
  • Bacterial acute rhinosinusitis (ABRS): Symptoms: 1. Persist for > 10 days without improvement, OR 2. Worsen ("double sickening") after an initial

improvement within 10 days

  • Fungal acute rhinosinusitis (in immunocompromised)

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