Sinusitis is the inflammation/infection of 1 or more paranasal sinuses and occurs when there is obstruction of the normal sinus drainage mechanism. It is traditionally subdivided into:
Patients usually complain of yellowish green foul smelling discharge and nose blockages.
Clinical examination might reveal tender cheek bones or tender forehead region.
Flexible fibreoptic endoscopy would reveal swollen nasal turbinates, mucopus within the middle or superior meatus streaking backwards into the nasopharynx. Often the natural sinus ostia would be obstructed and clogged with swelling of the nasal mucosa, pus or nasal polyps.
Acute or chronic sinusitis is a clinical diagnosis based on history and physical examination. In general, no imaging studies are required unless the patient requires surgery, pre-operative CT (computer tomography) scan of the sinuses are performed. Coronal sinus CT is the imaging study of choice in the evaluation of patients with sinusitis. The CT scan is done to delineate sinus anatomy, disease extent (which sinuses to operate on) and anatomical variants/bony landmarks. Plain sinus X-rays have limited role, but may be useful for air fluid levels.
Serious complications of acute and chronic are very rare; they include meningitis, and orbital abscesses. Prognosis is usually very good when detected early and drained surgically.
Management of acute is chiefly medication and supportive therapy. Medication includes culture directed antibiotic therapy (example penicillin based antibiotic), nasal decongestants, and topical oxymetazoline. Surgical intervention would be an antral wash out for the maxillary sinus. For chronic, medical therapy is often considered an adjunct to surgical treatment and is directed toward controlling predisposing factors, treating concomitant infections, reducing edema of sinus tissues, and facilitating the drainage of sinus secretions.
Advances in endoscopic technology and better understanding of the importance of the ostiomeatal complex (in the middle meatal region, lateral to the middle turbinate) in the pathophysiology have led to the establishment of functional endoscopic sinus surgery (FESS) as the surgical procedure of choice for the treatment of chronic sinus. FESS facilitates the removal of disease, restores adequate aeration and drainage of the sinuses by establishing patency of the ostiomeatal complex, and causes less damage to normal nasal functioning. FESS is successful in restoring sinus health, with complete or at least moderate relief of symptoms in 80-90% of patients.
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Viral sinusitis typically lasts less than 10 days, while bacterial sinusitis may last longer or worsen after an initial improvement. A doctor can help distinguish between them, as bacterial sinusitis may require antibiotics.
Decongestants, nasal corticosteroids, antihistamines (for allergy-related sinusitis), and antibiotics (for bacterial infections) are commonly used. Over-the-counter pain relievers can help manage symptoms.
Yes, mild cases can be managed with rest, hydration, saline nasal rinses, steam inhalation, and over-the-counter medications. Persistent or severe symptoms should be evaluated by Dr Kenny Pang.
Complications are rare but can include sinus infections spreading to surrounding tissues, including the eyes or brain, leading to issues like orbital cellulitis or meningitis.
Recurrent sinusitis may be due to untreated underlying issues such as allergies, nasal polyps, structural issues, or environmental factors. Treating these root causes can help prevent recurrence.
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