Acute Sinusitis

ACUTE SINUSITIS.
  • Acute inflammation of the paranasal sinuses.
ETIOLOGY OF ACUTE SINUSITIS
  • Acute Rhinitis:causing spread of infection to the sinuses by way of their natural ostia from the nasal cavities
  • Pharyngeal infection
  • Dental infection
  • Trauma
  • Predisposing factors:
  • Obstruction:Anatomical,Infective,Allergy,Tumours
INFECTING ORGANISM CAUSING ACUTE SINUSITIS
  • Viral:Rhinovirus,parainfluenza virus,respiratory synctial virus.
  • Bacteria:
  1. S. pneumoniae and nontypable Haemophilus influenzae are the most common pathogens, accounting for 50-60% of cases.
  2. Moraxella catarrhalis causes disease in a signigicant percentage (20%) of children but less often in adults
  • Fungi-Aspergillosis
  • Tuberculosis,syphilis-rare.
CLINICAL FEATURES OF ACUTE SINUSITIS 
The clinical symptoms of acute sinusitis have been classified into major and minor.
Major
  • Facial pain or pressure
  • Purulent nasal discharge
  • Fever
  • Nasal congestion
  • Nasal obstruction
  • Hyposmia or Anosmia
  • Facial congestion or fullness
Minor
  • Headache
  • Cough
  • Fatigue
  • Halitosis
  • Dental pain
  • Ear pain or pressure.
Characteristic findings of Acute Sinusitis
Sphenoid sinus:

  • Headache - usually localized to the occiput or vertex. Pain may also be referred to the mastoid region.
  • Isolated involvement of sphenoid sinus is rare. It is often a part of pansinusitis or is associated with infection of posterior ethmoidal sinus.
  • The reason for sphenoid sinus to be least affected is that it opens high up in the sphero ethmoid recess which is not affected by most of the conditions of nose
Maxillary sinus :
  • Along the infraorbital margin and referred to upper teeth or gums on affected side (along the distribution of superior orbital nerve).
  • Pain is aggravated on stooping or coughing.
  • Most common sinusitis in adults is Maxillary.
  • On rhinoscopy :pus or mucopus in in the middle meatus.
  • Tenderness is elicited at canine fossa.
Frontal sinus :
  • Pain localized over forehead.
  • It has a characteristic periodicity-Office headache
  • Tenderness elicited above the medial canthus.
Ethmoid sinus :
  • Pain localized over the nasal bridge, inner canthus and behind the ear.
  • Most common sinusitis in children is Ethmoid. 
INVESTIGATIONS IN A CASE OF ACUTE SINUSITIS
  • Radiology:May show Mucosal thickening,opacity of sinuses or Air-fluid level in case of Sinusitis.
  • Caldwell view is also known as occipitofrontal view or nose-forehead position. Structures seen are:
  • Frontal sinuses (seen best)
  • Ethmoid sinuses
  • Maxillary sinuses
  • Frontal process of zygoma and zygomatic process of frontal bone
  • Superior margin of orbit and lamina papyracea
  • Superior orbital fissure
  • Foramen rotundum (inferolateral to superior orbital fissure)
Water’s view(occipitomental view or nose-chin position).Structures seen are:
  • Maxillary sinuses (seen best)
  • Frontal sinuses
  • Sphenoid sinus (if the film is taken with open mouth)
  • Zygoma
  • Zygomatic arch
  • Nasal bone
  • Frontal process of maxilla
  • Superior orbital fissure
  • Bacteriological:examination if the sinusitis does not respond to antibiotic treatment.
  • Diagnostic Antral Puncture
  • Nasal Sinus Endoscopy:Most definitive diagnosis of Sinusitis.
TREATMENT OF ACUTE SINUSITIS
  • It is generally medical treatment
  1. Antibiotics,LocalDecongestants,Analgesic with Anti-inflammatory,Antihistaminic,Steam inhalation.
  2. Surgical :
  3. Antral puncture
  4. FESS.
  • Trephination of frontal sinus: indicated for frontal sinustis because of persistence or exacerbation of pain or pyrexia in spite of medical treatment for 48 hours.
CLINICAL CONDITIONS ASSOCIATED WITH SINUSITIS
  • Kartegenr's Syndrome:presents with recurrent sinusitis ,recurrent chest infections ,infertility and Chest X-ray revealing dextrocardia and situs invertus
  • Isolated IgA Deficiency:may suffer from chronic otitis and sinusitis, low serum IgA level and may suffer an anaphylactic reaction following the administration of blood products
 Exam Question
  • A minor symptom of sinusitis is Halitosis.
  • Most common sinus involved in infant and children is Ethmoid sinus.
  • Frontal Sinusitis-Pain shows periodicity,Tenderness is present just above the medial canthus of eye,Pain is referred to as office headache.
  • Pathognomonic feature of Maxillary sinusitis is Mucopus in the middle meatus.
  • Most definitive diagnosis of sinusitis is Sinoscopy.
  • Sphenoid sinusitis pain is referred most commonly to Occiput.
  • Common organisms causing sinusitis:S. pneumoniae and nontypable Haemophilus influenzae are the most common pathogens, accounting for 50-60% of cases. Moraxella catarrhalis causes disease in a signigicant percentage (20%) of children but less often in adults.
  • Sinus least involved in sinusitis is Sphenoid.
  • Probable diagnosis in a male patient presenting with recurrent sinusitis ,recurrent chest infections ,infertility and Chest X-ray revealing dextrocardia and situs invertus is Kartagener's syndrome.
  • Caldwell view of the X-ray is the best to show frontal sinus in a patient with recurrent frontal sinusitis.
  • Trephination is indicated for frontal sinustis because of persistence or exacerbation of pain or pyrexia in spite of medical treatment for 48 hours.
  • A 30-year-old,lady, with a history of chronic otitis and sinusitis, low serum IgA level suffering from isolated IgA deficiency may suffer an anaphylactic reaction following the administration of blood products
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