Sinusitis

 Sinusitis

Sinusitis is inflammation of paranasal sinuses.

Sinus is moist air space within around nose.

Sinus are lined mucus membrane that line nose and mouth.

A person suffer with cold and allergy, sinus tissue make more mucus and become swollen.

Drainage system of sinus get clogged and trapped in sinuses. 

Bacteria, virus, fungi growth in this medium and cause sinusitis.

Causes

1. Cold

2. Allergy

3. Nasal polyps

4. Infection

Stages of Sinusitis 

Type 1; Acute Sinusitis

Last last 2 to 4 weeks.

Type 2; Subacute Sinusitis

Last 4 to 12 weeks.

Type 3; Chronic Sinusitis

Last more than 12 weeks.

Type 4; Recurrent Acute Sinusitis

Several acute attack within a year

1. Acute Sinusitis 

Acute sinusitis start with common cold, caused by virus. 

Cold can swell sinuses and causes symptoms of sinusitis and leads to bacterial infection.

Inflammatory caused by cold result swelling in mucus membrane of sinuses, this can trapped air and mucus behind narrow opening of sinus drainage.

When the musus unae to drain from sinus, become source of nutrition for bacteria.

Clinical Manifestations

Depend upon which sinus are involved;

1. Maxillary Sinusitis 

Cause pain or pressure in maxillary area. 

2. Frontal Sinusitis 

Cause pain and pressure in frontal area.

Cause frontal headache.

3. Ethmoid Sinusitis

Localize pain over bridge of nose, inner canthus and between and behind the eyes.

4. Sphenoid Sinusitis

Cause pain and pressure behind the eyes.

Symptoms can include;

1. Bodyache

2. Decreased sense of smell

3. Tenderness on applying pressure

4. Sore throat

5. Bad Breath

6. Fever

7. Mucopurulent nasal discharge

8. Swelling eyelids

9. Severe cough at night

Diagnostic Evaluation

1. Examine nasal tissue

2. X-ray

3. Rhinoscopy; reveals nasal congestion and presence of mucus, pus in nose.

4. CT scan

Management

1. Antibiotic therapy

Amoxicillin-clavulanic

Clarithromycin

Doxycycline 

2. Nasal decongestant

Guaifenesin; mucolytic age t

3. Antihistamines

Diphenhydramine, Cetirizine

4. Steam inhalation 

2. Chronic sinusitis

In chronic sinusitis membrane of of both paranasal sinuses and nose are thickened.

Chronic sinusitis divided into-

1. Rhinosinusitis with nasal polyps (grape like growth of sinus membrane that protude into sinues or into nasal passages).

2. Rhinosinusitis without nasal polyps

Clinical Manifestations

1. Persistent nasal obstruction

2. Nasal congestion

3. Edema of Nasal mucus membrane

4. Sore throat

5. Thick green or yellow nasal discharge

6. Halitosis

7. Dryness of throat

8. Severe cough at night

9. Epistaxis

Diagnostic Evaluation

1. X ray of paranasal sinuses

2. Rhinoscopy

3. Nasal endoscopy

To examine nasal passages and sinus.

4. CT scan and MRI scan 

Management

1. Antibiotics

Amoxicillin-clavulanic

Clarithromycin

2. Nasal irrigation

Effective for opening blocked passages.

3. Nasal decongestant

4. Antihistamines 

Surgical Management

1. Antrum puncture

2. Balloon sinuplasty

Ballon sinuplasty allows to dilate a blocked sinus, creating open space, to sinus to drain.

3. Functional endoscopic sinus surgery (FESS)

4. Intranasal antrostomy

The procedure to clear the sinus opening on maxillary sinus.

5. Caldwell luc radical antrostomy

This procedure remove irreversibly damaged mucosa of the maxillary sinus. 

Prevention

1. Prevent upper respiratory airways infection

2. Nasal irrigation

3. Avoid dry, keep nose moist

5. Prevent exposure of allergic

6. Avoid long periods of swimming in pool treated with chlorine, which irritates lining of nose and sinuses

7. Avoid water driving, which forces into sinuses from nasal passages