Infections of the respiratory system can range from the common cold to life-threatening illness. Those with risk factors should be counseled about preventive measures. Vaccines against ﬂu and pneumonia should be offered as indicated.
Sinusitis A problem frequently encountered in women is self-diagnosed “sinus problems.” Many medical problems—headaches, dental pain, postnasal drainage, halitosis, and dyspepsia—may be related to sinus conditions. The sinuses are not an isolated organ, and diseases of the sinuses are often related to conditions that affect other portions of the respiratory system (i.e., the nose, bronchial tree, and lungs). The entire respiratory system can be infected by one particular virus or pathogen (the sinobronchial or sinopulmonary syndrome); however, the most prominent symptoms are usually produced in one anatomic area. Therefore, during the evaluation of symptoms attributable to sinusitis, the presence of other infections should be investigated.
Multiple infectious and chemical agents or reactions to nervous, physical, emotional, or hormonal stimuli may cause an inﬂammatory response in the respiratory system (1). Systemic diseases such as connective tissue syndromes and malnutrition may contribute to chronic sinusitis. Environmental factors in the workplace and geographic conditions (e.g., cold and damp weather) may aggravate or accelerate the development of sinusitis. Factors contributing to the development of sinus disease include atmospheric pollutants, allergy, tobacco smoke, skeletal deformities, dental conditions, barotrauma from scuba diving or airline travel, and neoplasms.
Most acute infections (lasting less than 4 weeks) begin with a viral agent in the nose or nasopharynx that causes inﬂammation, blocking the draining ostia (1). The location of the symptoms varies by anatomic site of infection—maxillary sinus over the cheeks, ethmoid sinus across the nose, frontal sinus in the supraorbital area, and sphenoid sinus to the vertex of the head—and typically last 7 to 10 days, clearing with nothing more than a decongestant. Viral agents impede the sweeping motion of ciliary function in the sinus and, in combination with edema from inﬂammation, may occasionally lead to superinfection with bacteria. The most common bacterial agents infecting sinuses are Streptococcus pneumoniae and Haemophilus inﬂuenzae. Gram-negative organisms are usually limited to compromised hosts in intensive care units. Although less than 2% of acute sinusitis cases transition from viral to bacterial infections requiring antibiotics, more than 85% of patients receive antibiotic prescriptions. Chronic sinusitis (lasting more than 12 weeks) develops from either inadequate drainage or compromised local defense mechanisms. The ﬂora usually is polymicrobial, consisting of aerobic and anaerobic organisms.