From the Guidelines
An aplastic sinus is a congenital anomaly that does not require specific treatment, as it is a normal anatomical variant and not a disease. This condition is most commonly found in the frontal sinuses, affecting approximately 5-15% of the general population 1. The diagnosis of an aplastic sinus is usually made incidentally during imaging studies, such as CT scans or MRIs of the head, and it is essential for clinicians to be aware of this variation to avoid unnecessary procedures or complications. Some key points to consider when evaluating an aplastic sinus include:
- The absence of a sinus can sometimes be mistaken for sinus disease or opacity on imaging 1
- Patients with aplastic sinuses typically experience no symptoms related to the condition itself
- The exact cause of sinus aplasia is not fully understood but is believed to result from developmental variations during embryological formation of the facial structures
- Clinicians should distinguish between viral rhinosinusitis (VRS) and presumed acute bacterial rhinosinusitis (ABRS) based on illness pattern and duration, as outlined in the clinical practice guidelines 1. However, these guidelines do not specifically address the management of aplastic sinuses, as they are not a disease entity. In clinical practice, the primary concern is to avoid misdiagnosing an aplastic sinus as a pathological condition, which could lead to unnecessary treatment or interventions. Therefore, it is crucial to recognize an aplastic sinus as a normal anatomical variation and not a condition that requires treatment, unless there are other underlying conditions that need to be addressed.
From the Research
Definition and Diagnosis of Aplastic Sinus
- Aplastic sinus is not directly mentioned in the provided studies, however, sinusitis is discussed in detail 2, 3, 4, 5, 6.
- Sinusitis involves a wide spectrum of presentations, both acute and chronic, and is primarily a medical condition, with surgical management reserved for complicated or refractory cases 4.
Causes and Symptoms of Sinusitis
- Acute bacterial sinusitis (ABS) is an extremely common problem in both children and adults, with three clinical presentations: onset with persistent symptoms, onset with severe symptoms, and onset with worsening symptoms 2.
- The predominant bacterial species implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 2.
- Symptoms of acute sinusitis include nasal symptoms or cough, high fever, and purulent nasal discharge 2, 3.
Treatment of Sinusitis
- Therapy for acute bacterial sinusitis may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, with alternatives including cefuroxime, cefpodoxime, or cefdinir 2.
- In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 2.
- A study comparing azithromycin extended release and amoxicillin/clavulanate found that more patients randomized to azithromycin extended release experienced symptom resolution at day 5 5.
- The optimal duration of therapy is unknown, with some recommending treatment until the patient becomes free of symptoms and then for an additional 7 days 2.