RHINOSINUSITIS

 
 

THE RHINOSINUSITIS

 
Rhinosinusitis is inflammation of the nasal cavity and sinuses. Patients with nasal obstruction, runny nose and changes in sense of smell are susceptible to presenting rhinosinusitis as the cause of orofacial pain. The European Headache Society has validated acute rhinosinusitis as a cause of Orofacial Pain.

Rhinosinusitis is known to affect about 5-15% of the European population. According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), rhinosinusitis is defined as the presence of 2 or more symptoms, one of which should include nasal congestion/obstruction or anterior/posterior nasal discharge. To confirm the diagnosis, nasal endoscopy (performed at the consultation) or computed tomography (CT) of the sinuses is necessary.

Thus, rhinosinusitis is unlikely to be the cause of orofacial pain in patients who does not have nasal symptoms.

 
 
 

PAIN IN RHINOSINUSITIS

 
Rhinosinusitis can be acute or chronic, if the duration of symptoms is less than or greater than 12 weeks, respectively. If chronic, it is classified as chronic rhinosinusitis with nasal polyps or chronic rhinosinusitis without nasal polyps.
 
CHRONIC PAIN
 
Pain in chronic rhinosinusitis without polyps is very uncommon except in cases of exacerbation. In chronic rhinosinusitis with polyps, pain is even more rare, with the predominant symptoms in this case being nasal obstruction and absence of sense of smell.
 
ACUTE PAIN
 
To the contrary, pain in acute rhinosinusitis is usually severe and unilateral, and if it affects the maxillary sinus, it can also include toothache.

The presence of pain in rhinosinusitis is a cause for concern as the active bacterial infection can lead to complications if left untreated (abscess of the orbit, meningitis, brain abscess).

 
DIAGNOSIS OF RHINOSINUSITIS
 
2 or more symptoms:
  • Nasal congestion/obstruction
  • Anterior/posterior nasal discharge
  • Facial pain/pressure

Changes in sense of smell and the presence of:
  • Changes in nasal endoscopy
  • Changes in CT of the sinuses
 
 
 
 
 

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