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.

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

1. Acute serous sinusitis: Congested, edematous mucosa with intact epithelium.
2. Acute purulent sinusitis: Neutrophilic infiltration, epithelial necrosis, and mucosal shedding.
3. 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.