What Is Sinusitis? Causes, Symptoms, Risk Factors, Diagnosis And Treatment

Sinusitis is defined as an inflammation or swelling of the tissue lining the paranasal sinuses.

What Are Sinuses?

Sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are about an inch in length across, while the others are smaller compared to this. They are lined by soft, pink mucous membrane. Maxillary sinuses are the largest sinus present in your cheekbones. The low centre of your forehead is where the frontal sinuses are located. In between your eyes are your ethmoid sinuses. Behind your nose is where your sphenoid sinuses are present. Normally these sinuses are empty except for a thin layer of mucus [1].

The Ethmoid and maxillary sinuses are present since birth. The frontal sinus develops during the second year of life and the sphenoid sinus develops during the third year. Sinuses have small orifices (ostia) which open into recesses (meatus) of the nasal cavities. Meatus are covered by turbinates (conchae). Turbinates consist of bony shelves. There are 3 turbinates and 3 meati in each nasal cavity, namely, superior, middle and inferior [2][3].

An acute inflammatory process, involving one or more of the paranasal sinuses, occurs when the ostia from the sinuses are narrowed or blocked by inflammation or hypertrophy of the mucosa. Maxillary and ethmoid sinuses are most frequently involved among all paranasal sinuses [4].

What Are The Causes Of Sinusitis?

• Bacterial sinusitis: Streptococcus pneumonia, haemophilus influenza, Beta Hemolytic streptococci, Klebsiella pneumonia.
• Viral sinusitis: Rhinovirus, influenza virus and adeno virus.
• Fungal sinusitis: Aspergillus and candida.

What Are The Signs And Symptoms Of Sinusitis?

• Pressure, pain or tenderness over sinuses
• Low-grade temperature, Malaise
• Persistent Nasal discharge, often purulent
• Postnasal drip - Upper airway cough syndrome
• Cough that worsens at night
• Mouth breathing, snoring
• Sore throat, bad breath
• Headache
• Nasal congestion, nasal obstruction
• Acute sinusitis - oedematous mucosa, discoloured purulent nasal drainage

What Are The Classification Of Sinusitis?

• Acute sinusitis: respiratory symptoms last up to four weeks.
• Subacute sinusitis: respiratory symptoms last between 4 to 12 weeks
• Chronic sinusitis: respiratory symptoms last more than 12 weeks.
• Recurrent acute: four or more episodes per year with a resolution of symptoms between attacks.

What Are The Risk Factors For Sinusitis?

• Allergies, nasal deformities, cystic fibrosis, nasal polyps and HIV infection
• Respiratory tract infection
• Cold weather
• Smoking inside the room/house

What Is The Pathophysiology Or Complications Of Sinusitis?

Usually follows rhinitis, which may be due to viral or allergic.
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Inflammation and oedema of mucous membranes lining the sinuses lead to obstruction of the sinuses.
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With inflammation, the mucosal lining of the sinuses produces mucoid drainage. Bacteria invade and pus accumulates inside the sinus cavities.
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If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities.
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Thus showing signs and symptoms.

And the complications as mentioned below:

• Cellulitis or abscess
• Meningitis
• Brain abscess
• Wheezing in children with asthma

How Is Sinusitis Diagnosed?

• Taking a good patient history is very important
• Physical examination
• X-ray
• CT, MRI
• Nasal Endoscopy - to examine the sinuses, obtain drainage for culture and restore normal drainage
• Rhinoscopy- Fiber optic examination of the nose

How Is Sinusitis Treated?

Usually, a case of sinusitis is managed through the adoption of the following measures:

• Antibiotics for 10 to 14 days, depending upon the severity.
• Antitussive for severe pain and cough
• Nasal sprays
• Painkiller if severe pain persists
• Decongestants to relieve nasal congestion
• Antihistamines

The non-pharmacological treatment includes the following:

• Humidifier to relieve the drying of mucous membrane associated with mouth breathing, steam inhalation
• Increase oral fluid intake (6 to 8 glasses of water)
• Moist heat over the affected sinus
• Saline irrigation of nostrils
• Prolonged warm shower to promote drainage
• Avoid smoking or exposure to smoke

Surgical management of sinusitis:

• Functional Endoscopic Sinus Surgery (FESS): uses fibre optic endoscope, diseased tissue which is located by CT scan will be dissected and promote sinus drainage and ventilation and remove decreased tissue and opens ostia.
• Caldwell-Luc Surgery: Otherwise known as Radical Antrum operation, a radical operation to the maxillary sinus performed through the oral vestibule and the diseased tissues are dissected and drained.
• Ethmoidectomy: Involves removal of ethmoid air cells, diseased mucosa, nasal polyps or mucocele are removed (mucocele- mucous cyst that leads to repeated infection). Ethmoidectomy is performed in 3 ways; transnasal, transantral and external.
• Sphenoid Sinus Surgery: Involves the endoscopic technique, removes ethmoid sinus and opens the anterior wall of the sphenoid sinus and the diseased tissue is removed along with mucus membrane lining the sinus.
• Frontal Sinusectomy: Involves Osteoplastic Flap Operation and the complete removal of diseased mucosa of the frontal sinus.
• Balloon Sinuplasty: The doctors use an endoscopic, catheter-based system to clear sinus passages of chronic sinusitis patients, allowing normal drainage of sinus fluid without removing tissue inside nasal cavities.

Sandeep RadhakrishnanHospice Care

MBBS

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