Definition

Acute rhinosinusitis (ARS) is an acute inflammatory condition of the nose and paranasal sinuses. As the mucosal lining of the nose and paranasal sinuses are continuous, ARS is a more appropriate term than the traditionally used acute sinusitis.

ARS is defined as (European Position Paper on Rhinosinusitis and Nasal Polyps – EPOS 2007):

• Sudden onset of two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip)

• Symptoms lasting less than 12 weeks
  
• In recurrent ARS, there must be symptom-free intervals present.

Pathophysiology

ARS usually develops as a result of a preceding viral upper respiratory tract infection which leads secondarily to a bacterial infection (Figure 19.1). Most of the sinuses drain in the middle meatus and congestion and obstruction of this part of the sinonasal anatomy is often implicated in ARS.

Cilia beat to guide secretions towards the natural sinus ostia for drainage. Blockage of the sinuses as a result of inflammation prevents drainage and results in stasis of mucous secretions, leading to development of an environment in which bacterial infection flourishes.

The most commonly implicated bacterial pathogens are the pyogenic or pus-forming organisms such as Streptococ­cus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

Presence of atopy, anatomical abnormalities (such as septal deviation and mechanical obstruction to sinus drainage pathways) and a history of chronic rhinosinusitis (with or without nasal polyposis) may predispose some individuals to devel­oping ARS. Sinonasal tumours and foreign bodies can also cause mechanical obstruction. Conditions affecting mucociliary clearance (e.g. cystic fibrosis, Kartagener’s syndrome) as well as immunodeficiency disorders are also risk factors for recurrent ARS.

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