Causes, Treatment, Classification of Sinusitis

What is Sinusitis?

Classification of Sinusitis / Photo source:

Paranasal sinuses are cavities in the skull, filled with air associated with the nasal cavities, and covered with mucous membranes covered with bone walls.

For various reasons, inflammation of the cavities may begin to infiltrate the mucous membranes of these cavities. This condition is called "Sinusitis" or "Rhinosinusitis".

Sinusitis usually occurs due to infections caused by viruses and resolves spontaneously within 10 days.

Classification of Sinusitis

Sinusitis Disease, according to the duration of the disease and relapse recurrence sinusitis disease is classified as follows:

- Acute sinusitis: Symptoms persist for up to 4 weeks
- Recurrent acute sinusitis: 4 or more episodes of sinusitis in 1 year
- Subacute sinusitis: Symptoms of sinusitis persist for 4-12 weeks. It can be defined as the transition period between acute and chronic sinusitis.
- Chronic sinusitis: Signs and symptoms of sinusitis last longer than 12 weeks.
- Acute exacerbation of chronic sinusitis: Chronic rhinosinusitis is a period of exacerbation of signs and symptoms, but returns to the onset after treatment.

Symptoms of Sinusitis

In sinusitis, the following symptoms may vary depending on the affected sinus and the duration of the disease:

- Headache (usually localized to the anterior face)
- Feeling fullness on the face
- Fire
- Inflammatory discharge from the nose and nose
- Weakness
- Bad breath
- Nasal congestion
- Cough
- Toothache

Causes of Sinusitis

Risk factors for sinusitis can be listed as follows:

- Increased intranasal mucosal edema due to prolonged viral upper respiratory tract infections

- cartilage curvature, nasal flesh growth, intranasal mass and nasal polyps, which may cause narrowing of the nasal discharge pathways

- Allergic rhinitis

- The presence of diseases that may affect the immune system or drug use

- Presence in a nursery environment, especially for children

- Smoking or exposure to cigarette smoke

Precautions For Sinusitis

Precautions for Sinusitis

To reduce the number of attacks of sinusitis, you should consider the following recommendations:

- Consumption of oral fluids and antioxidant seasonal fruits and vegetables during the period of seasonal changes. Some foreign sources have also reported reducing salt use, which is thought to increase mucosal edema when sinusitis begins.

- Pay attention to sleep patterns

- Regulation of appropriate medical treatment during allergic attacks

- A proposal that is especially important for those working in crowded environments; hand and face washing, washing the nose with water.

- Cessation of smoking and absence of cigarette smoke

- Influenza vaccination for people with frequent influenza

Smoking and exposure to cigarette smoke make sinusitis easier!

It has mucosal-like features covering the intranasal and pulmonary airways. On the mucosa, there are moving cilia, which are responsible for the backward movement of the secreted mucus secretion in the nose and the microbes and particles adhering to this secretion. Approximately 1-2 liters of mucus are produced per day. Sinus secretions, germs, particles and allergens entering the nose with respiratory air adhere to this mucus and are pushed backwards by cilia movements and then swallowed. Normally there is continuous production and conduction. Cigarette smoke disrupts the movement of cilia and this may cause the mucus layer to move towards the sinuses. In this way, it is easier for bacteria and particles to enter the sinuses. Many particles in cigarette smoke can directly facilitate bacterial infection. Chronic sinusitis is easier to occur in smokers and sinusitis treatment success is lower. Turbinates can grow on long-term exposure to air with allergens, infection residues or industrial residues and may require turbinate radiofrequency.

Sinusitis Treatment

Treatment of Acute Sinusitis

Acute Sinusitis

In the above photo, the patient has a complaint of fullness and headache after viral upper respiratory tract infection. Purulent dark discharge flowing down the right middle meatus is seen.

Acute sinusitis is a disease that usually resolves spontaneously with simple precautions and symptomatic medication. Antibiotics are also added to the treatment, especially in patients with fever, general body malaise and inflammatory nasal discharge lasting more than two days. It is also useful to treat the nose infection with salt water and steam baths containing menthol-eucalyptus.

Chronic Sinusitis Treatment

Treatment is more complex in the presence of diseases and conditions with cartilage curvature of the nose, flesh growth, polyps or masses, allergic structure, which facilitate the chronicization of sinusitis such as disease or drug use affecting the immune system. Treatments for underlying diseases and conditions may be required for the treatment of sinusitis. For example, surgery for polyp and cartilage curvature and endoscopic sinusitis surgery may be required.
Instead of the old surgical techniques used for the treatment of sinusitis, functional endoscopic techniques that minimize tissue damage and sinus surgeries can be performed with the help of balloon catheter.

Chronic left maxillary sinusitis Tomography

Unknown, complicating treatment of some drugs used in medical treatment of chronic sinusitis

Different drugs are used for the non-surgical medical treatment of sinusitis. Some of these medications and different side effects can be offered as follows:

- Some of the decongestant drugs may have sleep-related properties and others may have excessive stimulatory properties.

- Some intranasal cortisone sprays contain "benzalkonium chloride". This substance may slightly suppress the immune system and may be weak in patients with sinusitis. It has also been argued that this substance may have detrimental effects on epithelial integrity.

- Antihistaminic drugs given for allergy treatment, which is one of the underlying causes of chronic sinusitis, may cause dryness and darkening of secretions in the nose. Therefore, they can facilitate the growth of bacteria in darkened secretions; they may also facilitate obstruction of sinus emptying pathways.

- Nasal steroid sprays, when sprayed into the nose, can reduce the inflammation caused by allergic complexes. It has also been shown that after ingestion of allergic foods, intranasal inflammation by IgG complexes may increase.

Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS)

About 25 years ago, Austrian doctors, especially for the surgical treatment of chronic sinusitis. Messerklinger and dr. Functional endoscopic sinus surgery (FESS), developed by Stamberger and later popularized around the world, enables the treatment of sinusitis through the nose through minimally invasive methods. Balloon sinusitis can also be performed during FESS surgery.
By using endoscopes of different lengths and angles, operations can be performed through the nose to the sinus orifices and sinus emptying areas.

Recommendations in the Final Treatment Guide for Acute Bacterial Sinusitis

According to the Guideline for Managing Acute Bacterial Sinusitis, published by the American Infectious Diseases Society of America (IDSA) in 2012, only 2-10% of the patients with acute sinusitis are it has often been reported that simple cold viruses are responsible for acute sinusitis. Antibiotics are ineffective in virus infections. Therefore, most cases resolve spontaneously. In this last guideline, it is recommended to determine the distinguishing characteristics of the cases in terms of bacterial infection and to use Amoxicillin - Clavulanic Acid as the first treatment option in selected patients.

Similar links >> Endoscopic Sinus Surgery / Sinusitis - Definition, Symptoms, Causes, Complications and Treatment

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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