Post on 13-Apr-2015
description
An Inflammatory condition involving theparanasal sinuses and linings of the nasalpassages that lasts 12 week or longer
This diagnosis requires objective evidenceof mucosal inflammation
DEFINITION
Types of Rhinosinusitis per Temporal Course based on Duration of
Symptoms
ACUTE : lasts up to 4 weeks, with total resolution of symptoms
SUBACUTE : lasts > 4 weeks but < 12 weeks
RECURRENT ACUTE : 4 or more episodes per year, with resolution of symptoms between
attacks
CHRONIC : 12 weeks or more of signs / symptoms
ACUTE EXACERBATION OF CHRONIC RHINOSINUSITIS
Primary or secondary headache ?
Primary :- No other causative disorder
Secondary :- Headache occuring with another disorder
Headache attributed to rhinosinusitis commonly known as sinus headache is probably one of the most prevalent secondary headache
Chronic rhinosinusitis is not always associated with headache
Headache is experienced in three out of four patients with chronic rhinosinusitis ( Moretz , 2006)
Chronic rhinosinusitis gives a ninefold increased ofchronic headache (Aaseth, et al. 2010)
EPIDEMIOLOGY
• Sinusitis is overdiagnosed as a cause of headache and facial pain
• 60 % of patients with unrecognized migraine attrributed to their symptoms to sinusitis
• Rhinosinusitis is an uncommon cause of facial pain
• > 80% of patient with purulent secretions visible on nasal endoscopy have no facial pain
• The headache associated with rhinosinusitis are usually continuous
• Pain in maxillary sinusitis usually in the :
– Cheek– Gums– Maxillary teeth on affected side
• Pain in frontal sinusitis:
– frontal headache over the sinus– the medial side of the orbital floor– under the supra orbital ridge
CLINICAL FEATURES
Frontal sinusitis can result in :– Brain abscess– Meningitis– Subdural or epidural abscess– Osteomyelitis– Orbital edema– Orbital cellulitis
Ethmoid sinusitis typically produces pain in between the eyes– Coughing, straining and lying supine can worse the pain– Keeping the head upright lessen it
Complication of ethmoid sinusitis: meningitis, orbital cellulitis, cavernous sinus thrombosis
Headache is always present in sphenoid sinusitis :– Frontal– Temporal
Complication of sphenoid sinusitis:– Meningitis– Cavernous sinus thrombosis– Subdural abscess– Ophthalmoplegia– Pituitary insufficiency
A. Frontal headache accompanied by pain in one or more regions of the face, ears or teeth and fulfilling criteria C and D
B. Clinical, nasal endoscopic, CT and MRI imaging and/or laboratory evidence of acute or acute on chronic rhinosinusitis
C. Headache and facial pain develop simultaneously with onset or acute exacerbation of rhinosinusitis
D. Headache and/or facial resolution within 7 days after remission
DIAGNOSIS
Diagnostic criteria: (ICHD-II / IHS 2004)
Headache attributed to rhinosinusitis
Notes:
1. Clinical evidence may include purulence in the nasal cavity, nasal obstruction, hyposmia/anosmia
2. Chronic sinusitis is not validated as a cause of headache or facial pain unless relapsing into an acute stage.
A major challenge to studying headache attributed to sinus disease Lack of uniform diagnostic criteria
1. The AAO-HNS Classification: Headache as one
of several criteria for diagnosis
2. The ICHD-II/IHS Classification: Requires the existence of specific
pathophysiological condition that explain the headache
The ICHD-II does not accept chronic rhinosinusitis as a cause of headache or facial pain unless relapsing to an acute stage
Several primary headache : migraine, tension-type headache and cluster headache misclassified as
rhinosinusitis or sinusheadache
On the other hand, nasal and sinus related pain maymimic migraine attacks or Tension-type headache attacks
Major FactorsMajor Factors Minor FactorsMinor Factors
― Facial Pain / Pressure― Nasal Obstruction / Nasal Congestion― Nasal or Post-Nasal Discharge/ Purulence/ discoloured post nasal drainage― Hyposmia / Anosmia― Purulence in nasal cavity on examination
– Headache– Fever– Halitosis– Fatigue– Dental Pain– Cough – Otologic symptoms – Ear pain/pressure/fullness
Diagnostic criteria for Rhinosinusitis and headache attributed to rhinosinusitis (requires 2 Major Factors, or 1 Major & 2 Minor)
The AAO-HNS Classification
One of these signs of inflammation must be present and identified in association with ongoing symptoms consistent with chronic rhinosinusitis:
A.Discoloured nasal drainage from the nasal passages, nasal polyps or polypoid swelling as identified on physical examination with anterior rhinoscopy after decongestion or nasal endoscopy
B.Oedema or erythema of middle meatus or ethmoid bulla on nasal endoscopy
Migraine and tension-type headache are often confused with Headache attributed to rhinosinusitis because of similarity in location of the headache
Patients with chronic rhinosinusitis experience headache relief after sinus surgery
Topic nasal corticosteroids were reported as the second most frequent reason for headache improvement
( Aaseth, et al. Cephalalgia 2010, 30 (2) : 152-160 )
TREATMENT
SUMMARY
Chronic sinusitis is significantly associated with chronic headache
Both the classification of The AAO-HNS classification and The ICHD-II/IHS classification provide diagnostic criteria for the diagnosis rhinosinusitis related to headache
Patients with chronic rhinosinusitis experience headache relief after sinus surgery