Allergy-inducing mucosal edema can cause OMC obstruction, leading to sinusitis. It may, however, be very difficult to define the role of pure allergy in causing bacterial sinusitis in an individual patient.
Some practitioners believe that asthma can be triggered by sinusitis, and that if the sinusitis could be cured, bronchodilators would no longer be needed. Asthma and sinusitis may both be manifestations of an underlying disease, either an infection or an allergic inflammation in two of the respiratory tract locations, with one (the sinusitis) being superinfected. The mechanisms linking asthma with sinusitis are unclear, although several possibilities have been suggested. These include
• Inflammation as a result of mediators (cytokines) produced by the sinus mucosa
• Vagal neural reflex
• Damage from eosinophils found in both sinuses and bronchi
• Decrease in nitric oxide inhalation produced by the sinus epithelium
• Bacterial sinusitis is considered one of the many triggers of asthma.
• Viral URTI, a main inducer of sinusitis, can provoke wheezing in asthmatics, airway hyperreactivity, and small airway obstructive changes.
• Approximately 80% of patients with asthma also have a rhinitis syndrome.
• Approximately 10% of patients with perennial rhinitis suffer from asthma.
• Abnormal sinus radiographs are observed in a significant number of asthmatics.
Immune defects are found in a large number of children with recurrent or chronic bacterial sinusitis.
Indications for immunological screening include
• History of persistent sinus infection
• History of frequent infections at other sites
• Sinus culture reveals unusual pathogens
Immunologic abnormalities found in patients with chronic recurrent bacterial sinusitis
• Immunoglobulin A (IgA) deficiency
• Low immunoglobulin levels after vaccination
• Isolated immunoglobulin deficiency
• IgA, IgG2, and IgG3 deficiency
Human immunodeficiency (HIV) and bacterial sinusitis facts
• Bacterial sinusitis occurs in 80% of patients with HIV.
• The occurrence of sinusitis may be related to declining immune function manifested by decreasing CD4 cell counts.
• Qualitative and quantitative humoral immunity defects may play an important role in predisposing HIV-infected patients to bacterial sinusitis.
• Elevated serum IgE levels have been demonstrated, suggesting allergy-mediated inflammatory response, blocking the ostia.
• A mechanical impairment in drainage may result from local lymphoid hyperplasia.
• Smoking increases oropharyngeals colonization by respiratory pathogens and decreases colonization by normal flora organisms capable of interefering with pathogens.
• Smokers with sinustitis are more often infected by antibiotic resistant bacteria including Methicillin resistant Staphylococcus aureus (MRSA).
Genetic disorders (e.g., cystic fibrosis, diabetes) and syndromes that affect ciliary movement (immotile cilia syndrome, Kartagener’s syndrome, and Young’s syndrome) are associated with persistent sinus disease.
Both conditions interfere with clearance by harming the mucociliary system. Cystic fibrosis causes mucociliary dysfunction through hyperviscosity of the secretions, and patients often experience obstructive polypoid disease.
Enclosed are the conditions that predispose to bacterial sinusitis:
Conditions predisposing to bacterial sinusitis
Upper respiratory viral infection
Trauma to face
Rhinitis caused by medication (decongestants, beta blockers, antihypertensives, cocaine, birth control pills, aspirin)
Rhinitis caused by allergic/nonallergic causes
Chronic sinus infection*
Diving and swimming
Irritants: fumes, tobacco smoke
Gastroesophageal reflux (GER)
Mechanical and anatomical blockage
Nasal and sinus polyps
Cystic fibrosis (CF) and mutation in the gene responsible for CF
Foreign body in nose
Granulomatous disease: Wegener's granulomatosis
Cilia dyskinesia: primary ciliary dyskinesia, Kartagener's or Young's syndromes
Primary immune deficiency: IgA deficiency, common variable immune deficiency, X-linked agamma globulinemia, IgG dysfunction or subclass deficiency, complement deficiency, ataxia-telangiectasia, hyper-IgM syndrome
Deviated septum (congenital or traumatic)
Secondary immune deficiency: acquired immune deficiency syndrome
Debilitating conditions (chemo therapy, blood dyscrasias)
Conditions that lead to negative metabolism (e.g., malnutrition)
Osteomeatal complex abnormalities: large ethmoid bulla, abnormal uncinate process, concha bullosa, Haller air cells
Prolonged corticosteroid therapy
Nasogastric or nasotracheal catheters or tubes