Clinical picture of rhinusinusitis and management of out-patients [Inquadramento clinico della rinosinusite e gestione del paziente in ambulatorio]

Rhinosinusitis is generally due to the propagation of a nasal inflammation and may involve one or more paranasal sinuses. Depending on how long the disturbance lasts, it is classified as acute, acute recurrent and chronic. The acute and acute recurrent forms are resolved with appropriate medical therapy and there is no permanent damage to the mucosa, unlike the chronic form the pharmacological therapy of which does not determine complete anatomical pathological cure and for which the sole treatment is surgical. The incidence of this pathology lies in a range of between 0.5% and 10% depending on which author is reporting. Usually secondary to a viral infection (Rhinovirus, parainfluenzal virus 1, 2, 3, syncytial respiratory virus, adenovirus, enterovirus) it complicates following bacterial attack (S. pneumoniae, H. influenzae, M. Catarrhalis, anaerobic Streptococchi and Bacteroides). Runny nose, cephalea, slight persistent fever, cough, halitosis are the symptoms that characterise nasosinus phlogistic pathology although they are not exclusive to these conditions and can occur in other infectious situations (mucopurulent rhinitis, rhinoadenoiditis). Standard X-ray pictures do not provide constantly reliable diagnostic elements; by contrast, computed tomography (CT), magnetic resonance (MR) and optical fibre nasal endoscopy can provide precise information in view, for example, of a surgical programme. Antibiotic therapy is the cornerstone of the medical treatment of nasosinus infectious pathology. Among the antibiotics of choice we find amoxicillin clavulanate, the 2nd or 3rd generation oral cephalosporins, the ketolides and the quinolones. Other important therapeutic aids are those aimed at facilitating the reduction of the mucous oedema of the osteo-meatal complexes and drainage of secretions from the paranasal cavities and use of nasal washing with physiological solution, decongestion agents, mucolytics and possibly antihistaminics (allergic patients). Topical corticosteroids as shown by recent clinical studies most certainly represent a useful class of drugs for the management of rhinosinusitis. Surgical therapy is used on chronic and acutely complicated forms.