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.
-structural abnormalities, such as a deviated septum
-secondhand smoke is the cause of about 40% of chronic rhinosinusitis
Signs and symptoms :
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.
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.
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 :
-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
-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.
-mild personality changes, visual problems
-finally, seizures, coma, and possibly death.
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.
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.
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.
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…