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• Lesson
  • Content
    • 1 - Pathology of acuite nose and sinus infections
      • 1.1 - Acute rhinitis
        • 1 . 1 . 1 - Acute rhinitis in adults: the "common cold"
        • 1 . 1 . 2 - Clinical types
        • 1 . 1 . 3 - Treatment
    • 2 - Acute sinusitis
      • 2.1 - Anatomy review
      • 2.2 - Pathophysiology
      • 2.3 - Acute maxillary sinusitis
      • 2.4 - Diagnosis
      • 2.5 - Clinical types
        • 2 . 5 . 1 - By topography
        • 2 . 5 . 2 - Recurring infections
        • 2 . 5 . 3 - Hyperalgesia: severe acute maxillary or frontal sinusitis
        • 2 . 5 . 4 - Complicated infections
        • 2 . 5 . 5 - Immunocompromised hosts
      • 2.6 - Treatment
        • 2 . 6 . 1 - Guidelines for antibiotic therapy
        • 2 . 6 . 2 - Indications for antibiotic therapy
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1  -  Pathology of acuite nose and sinus infections

1 . 1  -  Acute rhinitis

1 . 1 . 1  -  Acute rhinitis in adults: the "common cold"

This is a contagious, epidemic condition especially common in autumn and winter, when fatigue, overwork, and stress seem to render the immune system more vulnerable. When patients say they have "caught a cold", this generally means they have been infected by a virus, such as rhinovirus, influenza, coronavirus, or the like.

Typically, patients start out feeling somewhat tired and perhaps sore, with chills and a heavy head. In the hours that follow, various other conditions may set in involving the nasopharynx (dryness, stinging, and burning) or the nasal cavities (itching, sneezing, rhinorrhea, and lacrimation), which is followed by unilateral, bilateral, or alternating nasal obstruction. Nasal discharge is clear, serous, and runny; sometimes very abundant, it irritates the upper lip and nostrils, forcing the patient to constantly blow his or her nose. Patients complain of frontal headaches, stuffy head, and often stuffy ears. There is generally little or no fever (38° C, 100.4° F).

On rhinoscopy, the mucous membrane is very red, with congestion from turbinate hypertrophy. After 2 to 3 days, the discomfort lessens and the discharge becomes thicker, colored (yellowish-green), and sometimes streaked with blood.

A few days later, the discharge changes again, becoming thinner, clearer, and more mucous. Finally, the amount of discharge diminishes, and the nasal obstruction disappears.

The duration and severity of acute rhinitis may vary from one patient to another, average duration being 8-20 days.

1 . 1 . 2  -  Clinical types

Acute rhinitis in newborns and infants


This type of rhinitis affects children under 6 months old, who breath only through their noses. Symptoms range from basic intermittent bilateral obstruction to respiratory distress requiring hospitalization.

Examination of the nasal cavities will show edema of the mucosa and swelling of the inferior turbinates to the point of contact with the septum. Differential diagnoses include choanal atresia, hypoplasia of the piriform apertures, and other facioskeletal malformations.

Nasopharyngitis in children

The clinical signs are noisy mouth-breathing combined with fever rarely higher than 38.5 °C (101.3 °F). Clinical examination reveals:

–        bilateral mucopurulent anterior rhinorrhea;

–        posterior rhinorrhea visible in the form of a thick mucopurulent coating over the posterior pharyngeal wall;

–        discrete redness of the pharyngeal mucosa;

–        swollen, inflamed, sensitive lymph nodes on both sides of the neck.

Otoscopy allows for ruling out acute otitis media: it generally reveals slight tympanic congestion or ground-glass appearance to the eardrum, with underlying anatomy still discernible and no bulging or earache.

Allergic rhinitis

Intermittent allergic rhinitis (formerly seasonal allergic rhinitis or hay fever) may present as acute rhinitis, but occurs predominantly in the spring. Its three clinical main signs are nasal obstruction, abundant colorless rhinorrhea, and sneezing fits, often combined with allergic conjunctivitis and an itchy palate. There is no infectious agent. Patients should be interviewed to determine exposure to one or more allergens, as well as any atopic predisposition. Skin tests should be administered in order to confirm specific IgE-dependent hypersensitivity.

1 . 1 . 3  -  Treatment

Uncomplicated acute nasopharyngitis or rhinitis is managed for symptoms only:

–        nasal cavities flushed with saline solution, then nose blown and/or aspirated (for babies);

–        analgesics if needed;

–        antipyretics if needed;

–        vasoconstrictors administered nasally in adults (unless contra-indicated) if obstruction is disabling.

Systemic antibiotic therapy is not justified in uncomplicated acute nasopharyngitis or rhinitis in either adults or children.