Sinusitis
Definition :
Sinusitis is the inflammation of the paranasal
sinuses, which may be due to infection, allergy or autoimmune issues. Most
cases are due to a viral infection and resolve over the course of 10 days.
Causes:
-allergies
-structural abnormalities, such as a deviated septum
-nasal polyps
-secondhand smoke is the cause of about 40% of chronic
rhinosinusitis
Signs and symptoms :
-headache :
Headache /facial pain or pressure of a dull,
constant, or aching sort over the affected sinuses is common with both acute
and chronic stages of sinusitis. This pain is typically localized to the
involved sinus and may worsen when the affected person bends over or when lying
down. Pain often starts on one side of the head and progresses to both sides.
Acute and chronic sinusitis may be accompanied by
thick nasal discharge that is usually green in colour and may contain pus or
blood often a localized heads he or toothache is present.
Pathophysiology :
The allergens,smoking,structural abnormalities in the sinuses
leads to nasal congestion as a result of the purulent filling of the sinuses.
As a result, there will be fullness, tenderness and pain referred to the head
of the client.
Classification :
By duration :
Sinusitis can be acute(going on less than
four weeks), subacute (4-8 weeks) or chronic (going on for 8 weeks or
more)
Acute sinusitis :
Acute sinusitis is usually precipitated by an
earlier upper respiratory tract infection. Generally of viral origin. If the
infection is of bacterial origin, the most common three causative agents are
streptococcus pneumonia, Haemophilus Influenzae, and Moraxella catarrhalis.
Chemical irritation can also trigger sinusitis, commonly from cigarettes and
chlorine fumes. Rarely, it may be caused by a tooth infection.
Chronic sinusitis :
Chronic sinusitis, by definition, lasts longer
than three months and can be caused by many different that share chronic
inflammation of the sinuses as a common symptoms.
Symptoms of chronic sinusitis may include any combination
of the following :
-nasal congestion
-facial pain
-headache
-night time coughing
-an increase in previously minor or controlled asthma
symptoms
-general malaise, thick green or yellow discharge
-feeling of facial 'fullness' or 'tightness'that may worsen when
bending over, dizziness, aching teeth or halitosis.
By location :
-maxillary sinusitis : can cause pain or pressure in the
maxillary area (e. g., toothache, headache)
-frontal sinusitis : can cause pain or pressure in the frontal
sinus cavity ( located behind /above eyes),headache
-ethmoid sinusitis : can cause pain or pressure between /behind
the eyes and headaches.
-sphenoid sinusitis : can cause pain or pressure behind the eyes,
but often refers to the vertex, or top of the head
Complications :
-the close proximity of the brain to the sinuses makes the most
dangerous complication of sinusitis, particularly involving the frontal and
sphenoid sinuses, infection of the brain by the invasion of anaerobic bacteria
through the bones or blood vessels.
-Abscesses
-meningitis
-mild personality changes, visual problems
-finally, seizures, coma, and possibly death.
Diagnosis :
Acute sinusitis :
Bacterial and viral acute sinusitis are difficult to
distinguish. However, if symptoms last less than 7 days,it is generally
considered viral sinusitis. When symptoms last more than 7 days, it is
considered bacterial sinusitis. Hospital acquired acute sinusitis can be
confirmed by performing a CT scan of the sinuses.
Chronic sinusitis :
For sinusitis lasting more than eight weeks,
diagnostic criteria are lacking. A CT scan is recommended, but this alone
is insufficient to confirm the diagnosis. Nasal endoscopy, a CT scan, and
clinical symptoms are all used to make a positive diagnosis. A tissue sample
for histology and cultures can also be performed and used. Allergic fungal
sinusitis is often seen in people with asthma and nasal polyps. Examining multiple
biopsy samples can be helpful to confirm the diagnosis.
Nasal endoscopy involves inserting a
flexible fiber-optic tube with a light and camera at its tip into the nose to
examine the nasal passages and sinuses. This is generally a completely painless
procedure which takes between five to ten minutes to complete.
Treatment :
Conservative :
Nasal irrigation may help with symptoms of chronic
sinusitis. Decongestant nasal sprays containing oxymetazoline may provide
relief, but these medications should not be used for more than the recommended
period. Longer use may cause rebound sinusitis.
Antibiotics :
The vast majority of cases of sinusitis are caused by
viruses and will therefore resolve without antibiotics. However,if symptoms
don't resolve within 7 days, amoxicillin is a reasonable antibiotic to use
first for treatment with amoxicillin /clavulanate being indicated when the
patient's symptoms do not improve an amoxicillin alone.
Surgery:
A relatively recent advance in the treatment of
sinusitis is a type of surgery called functional endoscopic sinus surgery
(FESS). This surgery removes anatomical and pathological obstructions
associated with sinusitis in order to restore normal clearance of the
sinuses.
A number of surgical approaches can be used
to access the sinuses and these have generally shifted from external approaches
to intranasal endoscopic ones. The benefit of the functional endoscopic sinus
surgery is it's ability to allow for a more targeted approach to the affected
sinuses, reducing tissue disruption, and minimizing post-operative
complications.
Another recently developed treatment Is balloon
sinusplasty. This method, similar to balloon angioplasty used to
"unclog" arteries of the heart, utilizes balloon in an attempt to
expand the openings of the sinuses in a less invasive manner. The utility of
this treatment for sinus disease is still under debate but appears promising...
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