ABSTRACT
I. Introduction 307
II. Epidemiological Aspects 308
III. Physiology and Pathophysiology of the Paranasal Cavities 310
IV. Acute Sinusitis Diagnosis and Management 312
V. Diagnosis and Management of Chronic and Recurrent Sinusitis 314
VI. Complementary Exams 320
A. Direct Observation and Imaging Examinations 320
B. Microbiological Examinations 324
VII. Conclusions 326
References 326
I. Introduction
Sinusitis cases form a peculiar group among the upper airway diseases, which are
difficult to confirm and to evaluate from the etiological and pathophysiological
standpoints and, therefore, become a problem for adequate therapeutic interven-
tion (1,2). Differently from the mouth and middle ear, paranasal cavities cannot
be directly seen at physical examination (3-5). Although collecting material
for exam is recommended in pharyngeal infections, it cannot be routinely
done in sinusitis (4). Causes are also difficult to determine, as different
chemicals (combustion particles, gases, pollen) and infectious agents can lead
to sinus inflammation (6-8). These aspects very often occur simultaneously or
sequentially, such as bacterial infections associated with allergic or viral rhino-
sinusal inflammations (6). Besides these initial difficulties in the evaluation of
sinusitis, others occur during evolution leading to limited possibilities of evalu-
ation of resolution and increased severity of local inflammation and sterilization
of cavity and mucosa; the same applies to recognition of cases of retained sinus
secretions (ostium obstruction) (9-11). Thus, several interpretations have been
proposed for the occurrence of sinusitis and the definition of diagnostic and thera-
peutic criteria (12-14).
