What is classified as pansinusitis?

Pansinusitis: Definition and Classification

Pansinusitis is defined as inflammation of all the paranasal sinuses (maxillary, ethmoid, frontal, and sphenoid sinuses) simultaneously. 1

Diagnostic Criteria

• Pansinusitis is a subtype of sinusitis (more accurately termed rhinosinusitis) that involves all of the paranasal sinuses 1
• The term "rhinosinusitis" is preferred over "sinusitis" because inflammation typically involves both the nasal cavity and sinuses simultaneously 1
• Diagnosis requires evidence of inflammation in all four pairs of paranasal sinuses (maxillary, ethmoid, frontal, and sphenoid) 1
• Like other forms of sinusitis, pansinusitis can be classified based on duration of symptoms 1:
  • Acute pansinusitis: symptoms lasting less than 4 weeks 1
  • Subacute pansinusitis: symptoms lasting 4-8 weeks 1
  • Chronic pansinusitis: symptoms lasting 8 weeks or longer 1

Clinical Presentation

• Symptoms of pansinusitis may include some or all of the following 1:
  • Persistent symptoms of upper respiratory tract infection
  • Purulent rhinorrhea (nasal discharge)
  • Postnasal drainage
  • Anosmia (loss of smell)
  • Nasal congestion
  • Facial pain or pressure (often more extensive than in localized sinusitis)
  • Headache
  • Fever
  • Cough
• Due to the extensive involvement of all sinuses, symptoms may be more severe and widespread compared to localized sinusitis 2, 3

Diagnostic Evaluation

• Imaging is essential for confirming pansinusitis diagnosis 1:
  • CT scan of the paranasal sinuses without contrast is the gold standard imaging modality 1
  • Findings should demonstrate mucosal thickening, air-fluid levels, or opacification in all paranasal sinuses 1
• Nasal endoscopy may be used to visualize purulent discharge and mucosal inflammation 4
• In chronic cases, CT scan is particularly important to document the extent of inflammation and to rule out complications 1

Clinical Significance and Complications

• Pansinusitis represents a more extensive inflammatory process than localized sinusitis 2
• It carries a higher risk of complications due to the extensive involvement of all sinuses 2, 3
• Potential complications include 2, 5:
  • Orbital cellulitis or abscess
  • Intracranial complications (meningitis, brain abscess)
  • Osteomyelitis of surrounding bones
  • Cavernous sinus thrombosis

Common Pitfalls and Caveats

• Not all mucosal thickening on imaging represents active sinusitis - up to 40% of asymptomatic adults may have abnormalities on sinus CT scans 1
• Imaging findings should always be correlated with clinical symptoms for accurate diagnosis 1
• The term "pansinusitis" should be reserved for cases with confirmed involvement of all paranasal sinuses, not just widespread but incomplete sinus disease 1
• In children, consider underlying conditions such as immunodeficiency or cystic fibrosis when pansinusitis is present 2
• Distinguishing between viral and bacterial etiology is important for appropriate treatment, particularly in acute cases 1

Treatment Considerations

• Treatment approach depends on whether the pansinusitis is acute, subacute, or chronic 1
• For acute bacterial pansinusitis, appropriate antibiotics are typically required 1, 5
• For chronic pansinusitis, longer-term medical therapy including intranasal corticosteroids and saline irrigation is often needed 4
• Surgical intervention may be necessary for cases that fail to respond to medical therapy or when complications develop 2, 3