Sinusitis
Sinusitis
or
rhinosinusitis is defined as an inflammation of the mucous
membrane that lines the paranasal sinuses. It can be due to
upper respiratory viral infection, allergy, nasal polyps,
deviated septum or autoimmune disases. Most sinusitis cases are
due to a viral infection and resolve over the course of 10 days.
Normally, sinuses are filled with air, but when sinuses become
blocked and filled with fluid, germs (bacteria, viruses, and
fungi) can grow and cause an infection.
Classification of sinusitis including:
- Acute sinusitis: Symptoms are present for 4
weeks or less. It is caused by bacteria growing in the sinuses.
A sudden onset of cold-like symptoms such as runny, stuffy nose
and facial pain that does not go away after 10 to 14 days.
- Subacute sinusitis: An inflammation lasting 4
to 12 weeks and represents a transition between acute and
chronic infection.
- Chronic sinusitis: Swelling and inflammation
of the sinuses are present for longer than 12 weeks. It may be
caused by bacteria or a fungus.
- Recurrent sinusitis: Several attacks within a
year (four or more acute sinusitis episodes that occur within
one year).
Acute Sinusitis
 |
| Acute Sinusitis |
Acute
sinusitis is defined as inflammation of the mucous membrane
of a sinus, especially of the paranasal sinuses for 4
weeks or less. It usually goes away without treatment. There are
various treatments that may help to ease symptoms. Antibiotics
are only sometimes needed.
A simple examination of the nose or endoscopic examination is
usually sufficient for diagnosis.
New American Academy of Pediatrics (AAP) guidelines for acute
bacterial sinusitis published online June 24 in Pediatrics.
Changes include:
- Previous diagnostic criteria for acute bacterial sinusitis
in children were acute upper respiratory tract infection (URI)
with either nasal discharge and/or daytime cough for longer than
10 days or severe onset of fever, purulent nasal discharge, and
other respiratory symptoms for 3 or more consecutive days. A
third criterion added to the updated guideline is URI with
worsening symptoms such as nasal discharge, cough, and fever
after initial improvement.
- Physicians may now observe children with persistent
infection lasting longer than 10 days for an additional 3 days
before prescribing antibiotics, but antibiotics should still be
given to children with severe onset or worsening symptoms.
- First-line therapy is amoxicillin with or without
clavulanate.
- Imaging tests are not recommended for children with
uncomplicated acute bacterial sinusitis, although children with
suspected orbital or CNS complications should undergo CT
scanning of the paranasal sinuses.
Chronic Sinusitis
 |
| Chronic Sinusitis |
Chronic
sinusitis can cause persistent sinusitis symptoms (nasal
congestion, facial pain, headache, night-time coughing ...) lasts
longer than three months and it can be caused by different diseases
that share chronic inflammation of the sinuses as a common symptom.
When
nasal
polyps are present, the condition is called chronic
hyperplastic
sinusitis.
Chronic rhinosinusitis always associated with impaired sinus
drainage and secondary bacterial infections.
Causes of Chronic Sinusitis
The presence of the following diseases and conditions can cause chronic sinusitis:
- Nasal polyps, tumor and other space-occupying lesions in the nose
- Allergic reactions
- Nasal septum deviation
- Facial trauma (Broken facial bone may cause blockage of sinus passages)
Other medical conditions:
- Cystic fibrosis
- Gastroesophageal reflux
- HIV and other immune system related diseases
- Respiratory infections. (These infections can be viral, bacterial or fungal in nature.)
- Allergic diseases such as hay fever.
Signs and Symptoms of Sinusitis
 |
| Signs and Symptoms of Sinusitis |
Facial pain and pressure in the face along with a stuffy or runny
nose are the main symptoms of sinusitis.
The location of pain and tenderness may depend on which sinus is
affected.
Other common symptoms of sinusitis include:
- Headache
- Bad breath (halitosis)
- Yellow or greenish discharge from the nose or down the back of
the throat
- Stuffy nose
- Cough that produces mucus
- Fever
- Tooth pain
- Reduced sense of taste or smell
Chronic sinusitis and acute sinusitis have similar signs and
symptoms, but acute sinusitis is a temporary infection of the
sinuses often associated with a cold. At least two of the following
signs and symptoms must be present for a diagnosis of chronic
sinusitis:
- Drainage of a thick
- Yellow or greenish discharge from the nose or down the back of
the throat
- Nasal obstruction or congestion
- Pain, tenderness and swelling around eyes, cheeks, nose or
forehead
- Reduced sense of smell and taste
Causes of Sinusitis
 |
| Sinusitis Causes |
Factors which can cause to developing sinusitis
include:
- Upper respiratory viral infections: The most common viral
infections that lead to sinusitis are cold and flu infections. These
viruses can spread to the sinuses from the upper airways. If a
secondary bacterial infection develops, thick yellow or green mucus
will be produced and sinuses will become inflamed and swollen.
- Allergies such as allergic rhinitis, asthma and hayfever
- Structural abnormalities, such as a deviated septum, small
sinus ostia or a concha bullosa; nasal polyps
- Genetic causes such as carrying the cystic fibrosis gene (thick,
sticky mucus builds up within the body, increasing the risk of
infection)
- Both smoking and second hand smoke are associated with chronic
rhinosinusitis
- Irritants: air pollution, smoke and chemicals, such as
pesticides, disinfectants and household detergents
Diagnosis of Sinusitis
 |
| Sinusitis Diagnosis |
Acute sinusitis can be diagnosed with patient's symptoms and
endoscopic examination of the nose.
However more detailed examination of patient and several other
methods may be require for chronic sinusitis diagnosis such as:
- Nasal endoscopy (This also is known as rhinoscopy). A thin,
flexible tube (endoscope) with a fiber-optic light inserted through
your nose allows your doctor to visually inspect the inside of your
sinuses.
- Imaging studies. Images taken using computerized tomography
(CT) or magnetic resonance imaging (MRI) can show details of your
sinuses and nasal area. These may identify a deep inflammation or
physical obstruction that's difficult to detect using an endoscope.
- Nasal and sinus cultures. Cultures are generally unnecessary
for diagnosing chronic sinusitis. However, in cases in which the
condition fails to respond to treatment or is progressing, tissue
cultures may help pinpoint the cause, such as bacteria or fungi.
- Allergy tests. A skin test is safe and quick and can help
pinpoint the allergen that's responsible for nasal flare-ups.
Complications of Sinusitis
 |
| Complications of Sinusitis |
Complications of sinusitis include acute and chronic sequelae.
Acute distant effects include toxic shock syndrome. Acute local
effects can also occur. Acute orbital complications include the
following: cellulitis, proptosis, chemosis, ophthalmoplegia, orbital
cellulitis, subperiosteal abscess, and orbital abscess. Other acute
complications include intracranial sequelae such as meningitis;
encephalitis; cavernous or sagittal sinus thrombosis; or extradural,
subdural, or intracerebral abscesses.
Bony complications include dental involvement and osteitis or
osteomyelitis.
Potts puffy tumor refers to swelling of the scalp, caused by an
underlying osteitis of the skull or extradural abscess.
Chronic sinusitis complications include:
- Asthma flare-ups. Chronic sinusitis can trigger an asthma
attack.
- Meningitis. This infection causes inflammation of the membranes
and fluid surrounding your brain and spinal cord.
- Vision problems. If infection spreads to your eye socket, it
can cause reduced vision or even blindness that can be permanent.
- Aneurysms or blood clots. Infection can cause problems in the
veins surrounding the sinuses, interfering with blood supply to your
brain and putting you at risk of a stroke.
Treatment of Sinusitis
 |
| Treatment of Sinusitis |
Treatment of sinusitis include conservative preautions, medical
treatment surgical treatment.
Conservative treatment methods include nasal irrigation,
applying a warm, moist cloth, drinking sufficient fluids and
inhaling low temperature steam two to four times a day.
Medical treatment include antibiotic, decongestant, analgesic and
corticosteroid treatmens.
Surgical treatment procedures perform for especially chronic or
recurring sinusitis. A number of surgical approaches can be used to
access the sinuses and these have generally shifted from external /
extranasal approaches to intranasal endoscopic ones. The benefit of
Functional Endoscopic Sinus Surgery (
FESS)
is its ability to allow for a more targeted approach to the affected
sinuses, reducing tissue disruption, and minimizing post-operative
complications.
You can find more detail about endoscopic sinus surgery at >>
www.ent-istanbul.com/2018/04/endoscopic-sinus-surgery.html
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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