Adult Chronic Sinusitis and Its Complications

By G. Douglas Campbell Jr., MD, FCCP

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This paper will review the anatomy of the sinuses and the pathophysiology of chronic rhinosinusitis, discuss appropriate strategies for the recognition and medical management of rhinosinusitis, and briefly review situations in which surgical intervention should be considered.

Anatomy

While there is some uncertainty as to the function of the paranasal sinuses, their presence appears to be beneficial by reducing the bony weight of the skull, warming and humidifying inspired air, and adding resonance to vocalization.

The paranasal sinuses consist of four independently draining cavities located on either side of the nasal septum. These paired cavities are the frontal, maxillary, ethmoid, and sphenoid sinuses (Fig 1). The frontal, maxillary, and anterior ethmoid sinuses drain into the nasal area through the middle turbinate via the osteomeatal complex, and the posterior ethmoid and sphenoid sinuses drain into the superior turbinate through the sphenoethmoidal recess. The sinuses, like the bronchi, are lined with ciliated pseudostratified columnar cells, and the presence of numerous goblet cells ensures the constant production of mucus to trap particulate matter and desquamative material that the cilia then propel into the nasopharynx. In each sinus, there is a complete change of the mucous blanket every 20 to 30 min!¹⁵ For the sinuses to function properly, flow from the sinuses through the ostia (which are approximately 1 to 3 mm in diameter) into the nasopharynx must be unimpeded.

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