Chronic Sinusitis Differential Diagnoses

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Feb 15, 2012
 
 

Diagnostic Considerations

Problems to be considered include the following:

  • Temporomandibular joint syndrome
  • Asthma
  • Other chronic rhinitis
  • Nasal and sinus cavity tumors
  • Facial pain attributable to other causes
  • Nasal polyp
  • Dental infection
  • Periodontal abscess
  • Antral-choanal polyp
  • Inverting papilloma
  • Aspirin/nonsteroidal anti-inflammatory drug sensitivity
  • Chronic headache of other etiology

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Coauthor(s)

Osama A Abdel Razek, MD, MBBCh, MSc  Lecturer in ENT, Suez Canal University Medical School, Egypt

Disclosure: Nothing to disclose.

Seth M Brown, MD, MBA, FACS  Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Director, The Connecticut Sinus Institute

Seth M Brown, MD, MBA, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, and North American Skull Base Society

Disclosure: Nothing to disclose.

Marvin P Fried, MD, FACS  Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine

Marvin P Fried, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, American Society of Plastic and Reconstructive Surgery, Massachusetts Medical Society, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Medtronic Consulting fee Consulting

Daniel R Hinthorn, MD  Director, Division of Infectious Diseases, Professor, Departments of Internal Medicine, Pediatrics and Family Medicine, University of Kansas

Daniel R Hinthorn, MD is a member of the following medical societies: American Academy of Family Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert M Kellman, MD  Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: GE Healthcare Honoraria Review panel membership; Revent Medical Honoraria Review panel membership

Ankit Patel, MD  Staff Physician, Department of Otolaryngology-Head and Neck Surgery, St Joseph Medical Center, Silver Cross Hospital

Ankit Patel, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society

Disclosure: Nothing to disclose.

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

David Rubinstein, MD  Associate Professor, Department of Radiology, University of Colorado Health Sciences Center

David Rubinstein, MD is a member of the following medical societies: American Society of Neuroradiology and Radiological Society of North America

Disclosure: Nothing to disclose.

Babak Sadoughi, MD  Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine

Babak Sadoughi, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Association for Research in Otolaryngology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Belachew Tessema, MD  Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Co-director, The Connecticut Sinus Institute

Belachew Tessema, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society

Disclosure: Nothing to disclose.

Winston C Vaughan, MD  Founder and Director, California Sinus Institute and Foundation; Director, CSI Advanced Sinus Surgery and Rhinology

Disclosure: Nothing to disclose.

Specialty Editor Board

Lanny Garth Close, MD  Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons

Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Eleftherios Mylonakis, MD, A John Vartanian, MD, Louis de Guzman Portugal, MD, FACS, Charles Lee, MD, Sanford M Archer, MD, and Dennis Poe, MD, to the development and writing of the source articles.

References

  1. American Academy of Pediatrics - Subcommittee on Management of Sinusitis and Committee on Quality Management. Clinical practice guideline: management of sinusitis. Pediatrics. Sep 2001;108(3):798-808. [Medline].

  2. Slavin RG, Spector SL, Bernstein IL, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. Dec 2005;116(6 Suppl):S13-47. [Medline].

  3. Report of the Rhinosinusitis Task Force Committee Meeting. Alexandria, Virginia, August 17, 1996. Otolaryngol Head Neck Surg. Sep 1997;117(3 Pt 2):S1-68. [Medline].

  4. Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. Sep 2003;129(3 Suppl):S1-32. [Medline].

  5. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. Dec 2004;114(6 Suppl):155-212. [Medline].

  6. Biel MA, Brown CA, Levinson RM, Garvis GE, Paisner HM, Sigel ME, et al. Evaluation of the microbiology of chronic maxillary sinusitis. Ann Otol Rhinol Laryngol. Nov 1998;107(11 Pt 1):942-5. [Medline].

  7. Brook I, Frazier EH, Foote PA. Microbiology of the transition from acute to chronic maxillary sinusitis. J Med Microbiol. Nov 1996;45(5):372-5. [Medline].

  8. Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol. Aug 2008;57:1015-7. [Medline].

  9. Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am. Jun 2007;21(2):427-48, vii. [Medline].

  10. Brook I. Bacteriology of chronic maxillary sinusitis in adults. Ann Otol Rhinol Laryngol. Jun 1989;98(6):426-8. [Medline].

  11. Incorvaia C, Leo G. Treatment of rhinosinusitis: other medical options. Int J Immunopathol Pharmacol. Jan-Mar 2010;23(1 Suppl):70-3. [Medline].

  12. Brook I, Yocum P. Immune response to Fusobacterium nucleatum and Prevotella intermedia in patients with chronic maxillary sinusitis. Ann Otol Rhinol Laryngol. Mar 1999;108(3):293-5. [Medline].

  13. Brook I, Foote PA, Frazier EH. Microbiology of acute exacerbation of chronic sinusitis. Laryngoscope. 2004;114:129-31.

  14. Nadel DM, Lanza DC, Kennedy DW. Endoscopically guided cultures in chronic sinusitis. Am J Rhinol. Jul-Aug 1998;12(4):233-41. [Medline].

  15. Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am. Apr 2000;33(2):227-35. [Medline].

  16. Pleis JR, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2007. Vital Health Stat 10. May 2009;1-159. [Medline].

  17. Shah AR, Hairston JA, Tami TA. Sinusitis in HIV: microbiology and therapy. Curr Allergy Asthma Rep. Nov 2005;5(6):495-9. [Medline].

  18. Brook I. Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol. Sep 2009;73(9):1183-6. [Medline].

  19. Chakrabarti A, Denning DW, Ferguson BJ, et al. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. Sep 2009;119(9):1809-18. [Medline]. [Full Text].

  20. Marple BF, Stankiewicz JA, Baroody FM, et al. Diagnosis and management of chronic rhinosinusitis in adults. Postgrad Med. Nov 2009;121(6):121-39. [Medline].

  21. Rosenfeld RM. Clinical practice guideline on adult sinusitis. Otolaryngol Head Neck Surg. Sep 2007;137(3):365-77. [Medline].

  22. Benninger MS, Payne SC, Ferguson BJ, Hadley JA, Ahmad N. Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. Jan 2006;134(1):3-9. [Medline].

  23. Wise SK, Ahn CN, Lathers DM, Mulligan RM, Schlosser RJ. Antigen-specific IgE in sinus mucosa of allergic fungal rhinosinusitis patients. Am J Rhinol. Sep-Oct 2008;22(5):451-6. [Medline].

  24. United States Food and Drug Administration. Zicam cold remedy nasal products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Saws, Kids Size). MedWatch Public Health Advisory. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm. Accessed June 16, 2009.

  25. Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. Mar 1 2011;154(5):293-302. [Medline].

  26. Catalano PJ, Payne SC. Balloon dilation of the frontal recess in patients with chronic frontal sinusitis and advanced sinus disease: an initial report. Ann Otol Rhinol Laryngol. Feb 2009;118(2):107-12. [Medline].

  27. Ferguson BJ, Narita M, Yu VL, Wagener MM, Gwaltney JM Jr. Prospective observational study of chronic rhinosinusitis: environmental triggers and antibiotic implications. Clin Infect Dis. Jan 2012;54(1):62-8. [Medline].

  28. Bhattacharyya N. Radiographic stage fails to predict symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. Jan 2006;116(1):18-22. [Medline].

  29. Welch KC, Stankiewicz JA. A contemporary review of endoscopic sinus surgery: techniques, tools, and outcomes. Laryngoscope. Nov 2009;119(11):2258-68. [Medline].

  30. Hox V, Delrue S, Scheers H, Adams E, Keirsbilck S, Jorissen M, et al. Negative impact of occupational exposure on surgical outcome in patients with rhinosinusitis. Allergy. Jan 9 2012;[Medline].

  31. Ponikau JU, Sherris DA, Weaver A, Kita H. Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, double-blind pilot trial. J Allergy Clin Immunol. Jan 2005;115(1):125-31. [Medline].

  32. Sacks PL, Harvey RJ, Rimmer J, Gallagher RM, Sacks R. Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis. Cochrane Database Syst Rev. Aug 10 2011;CD008263. [Medline].

  33. Gupta AK, Bansal S, Gupta A, Mathur N. Is fungal infestation of paranasal sinuses more aggressive in pediatric population?. Int J Pediatr Otorhinolaryngol. Apr 2006;70(4):603-8. [Medline].

  34. Hakim HE, Malik AC, Aronyk K, Ledi E, Bhargava R. The prevalence of intracranial complications in pediatric frontal sinusitis. Int J Pediatr Otorhinolaryngol. Aug 2006;70(8):1383-7. [Medline].

  35. Sharma GD, Doershuk CF, Stern RC. Erosion of the wall of the frontal sinus caused by mucopyocele in cystic fibrosis. J Pediatr. May 1994;124(5 Pt 1):745-7. [Medline].

 
Previous
Next
 
Endoscopic view right nasal cavity; lacrimal bone (L), uncinate process (U), ethmoid bulla (B), middle turbinate (MT), nasal septum (S).
Air-fluid level (arrow) in the maxillary sinus suggests sinusitis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.