Sinusitis
Introduction
Cause and Pathogenesis
Symptoms and Signs
Investigations and Diagnosis
Treatment and Prognosis
Prevention
Introduction
Sinusitis is a common problem caused by acute or chronic inflammation of the paranasal sinuses. The
paranasal sinuses are aerated cavities in the bones of the face that develop from the nasal cavity and maintain
communication with it. The main sinuses are the maxillary, the frontal, the ethmoid, and the sphenoid sinuses. Maxillary
sinusitis is the most common type of sinusitis. The ethmoid, frontal and sphenoid sinuses are affected less frequently.
Cause and Pathogenesis
Sinusitis is caused by a variety of bacteria such as streptococci, staphylococci, pneumococci and
Haemophilus influenzae viruses such as the influenza and the parainfluenza virus and less commonly by fungi such as
aspergillus. Sinusitis often begins after an acute respiratory infection, which very often could be viral. Less commonly it
may occur after a tooth extraction or other dental procedures, or after diving or swimming in contaminated water. Sometimes
sudden changes in the climate, especially the sudden movement into cold climes, can also trigger an attack. Patients with
AIDS, and other immunocompromized patients are more prone to attacks of fungal sinusitis. An attack begins with the
inflammation of the nasal mucous membrane. This causes an obstruction of the opening of the sinus leading eventually to
secretions accumulating in the sinus with associated pain and swelling. The secretions get infected exacerbating the
situation.
Symptoms and Signs
Patients with sinusitis usually present with malaise, mild fever and headache, and nasal discharge.
The area of the face over the inflamed sinus may even appear swollen in some cases. Maxillary sinusitis may cause pain in
the maxillary area of the face, toothache, and frontal headache. Frontal sinusitis causes frontal pain and headache. Ethmoid
sinusitis causes pain behind the eyes and frontal headache. Sphenoid sinusitis causes pain in the occipital region. The
risks of sinusitis is that it can become chronic or lead to complications such as orbital cellulitis, meningitis and brain
abscess, which can even be fatal.
Investigations and Diagnosis
An X-ray of the para nasal sinuses is often the first test done. Haziness or opacities in the region of
the infected sinus is often seen. Sometimes a CT Scan may be required for confirmation. The discharge from the sinus is sent
for culture and the organism isolated, and appropriate antibiotics may be given. Sometimes transillumination of the involved
sinus may be helpful. The affected sinus produces a dark shadow as opposed to a normal sinus, which produces a light shadow.
Tests to check for the presence of infection and ESR may be done to gather supportive evidence. Fungal scrapings and smears
may be taken from the discharge and fungal cultures have to be done if a fungal aetiology is suspected.
Treatment and Prognosis
The treatment may be either medical or surgical. The initial treatment involves administration of
appropriate antibiotics along with an analgesic and an anti-histaminic. Steam inhalation and nasal spray could also provide
relief and may be used to relieve the congestion. Avoiding nasal irritants and allergens may help. Irrigation and drainage
of the affected sinus is sometimes done.
Surgical treatment involves puncturing the sinus and making a window in it to facilitate easy drainage. Other procedures
include the Caldwell-Luc procedure for chronic maxillary sinusitis and ethmoidectomy for ethmoid or sphenoid sinusitis. The
prognosis is often quite good and depends upon the sinuses involved and the duration of the infection. Most patients who
have acute sinusitis of a short duration generally recover with appropriate early therapy. However chronic sinusitis can be
quite a problem and even after drainage patients may be symptomatic. Some patients may require radical surgical techniques
for cure.
Prevention
While there are no vaccines to prevent sinusitis and it is impossible to predict who will develop it
except in a small number of patients who have an anatomic defect in their nose, early diagnosis and treatment is the only
practical solution.
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