Sinusitis
Sinusitis refers to inflammation of the paranasal sinuses, often secondary to rhinitis. It can affect one or multiple sinuses, with maxillary sinusitis being the most common.
Contents
Key Points
- Classified as acute or chronic based on duration and severity.
- Common symptoms include nasal congestion, purulent rhinorrhea, and facial pain.
- Complications include orbital cellulitis, meningitis, and brain abscess.
- Management focuses on improving drainage, controlling infection, and addressing underlying causes.
Etiology and Pathogenesis
- Infectious causes: Bacterial (e.g., Streptococcus pneumoniae, Haemophilus influenzae), viral, or fungal pathogens.
- Non-infectious factors: Allergies, anatomical abnormalities (e.g., deviated septum), barotrauma, dental infections.
- Pathophysiology: Impaired sinus drainage and ventilation lead to mucosal inflammation, congestion, and secondary infection.
Pathological Changes
- Acute serous sinusitis: Congested, edematous mucosa with intact epithelium.
- Acute purulent sinusitis: Neutrophilic infiltration, epithelial necrosis, and mucosal shedding.
- Chronic sinusitis: Thickened mucosa, vascular changes, lymphocytic infiltration, and polyp formation.
Clinical Features
- Nasal symptoms: Congestion, purulent rhinorrhea, postnasal drip.
- Facial pain: Localized to affected sinus; worsens with bending forward.
- Systemic symptoms: Fever, fatigue, malaise (more common in acute cases).
- Complications: Osteomyelitis, orbital cellulitis, meningitis, brain abscess, sepsis.
Diagnosis
- History and physical exam: Duration of symptoms, nasal discharge, sinus tenderness.
- Imaging: Sinus CT scan for chronic or complicated cases.
- Laboratory tests: Culture of nasal discharge for refractory or severe infections.
Treatment Principles
General Measures
- Strengthen physical fitness and immunity.
- Avoid triggers (e.g., allergens, smoking) and prevent colds.
- Improve living and working environments.
Medical Management
- Nasal irrigation: Saline rinses to clear mucus and improve drainage.
- Intranasal corticosteroids: Reduce inflammation and edema.
- Antibiotics: For bacterial sinusitis; guided by culture when possible.
- Decongestants: Short-term use to relieve nasal obstruction.
Surgical Management
- Functional endoscopic sinus surgery (FESS): For refractory or complicated cases.
- Polypectomy: Removal of nasal polyps to restore drainage.
Prevention
- Maintain good nasal hygiene and hydration.
- Address underlying conditions (e.g., allergies, anatomical abnormalities).
- Regular exercise and balanced nutrition to boost immunity.
Complications and Referral
- Complications: Orbital cellulitis, intracranial extension, abscess formation.
- Referral criteria: Refractory symptoms, recurrent infections, or suspected complications.
Patient Education
- Complete prescribed treatments and follow up as advised.
- Use saline irrigation regularly to prevent recurrence.
- Seek medical attention for worsening symptoms or signs of complications.
