Sinusitis

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Sinusitis is inflammation of the paranasal sinuses from either bacterial, fungal, viral, allergic or autoimmune issues.

Contents

1 Classification

1.1 By location
1.2 Acute vs. chronic

1.2.1 Acute sinusitis
1.2.2 Chronic sinusitis
1.2.3 Sinus headache

2 Diagnosis
3 Treatment
4 External links

Classification

By location

Sinusitis is classified by the sinus cavity which it affects:

Maxillary sinusitis - causes pain in the maxillary area (e.g., toothache, headache) (J01.0/J32.0)

Frontal sinusitis - causes pain in the frontal sinus cavity (located behind/above eyes), headache (J01.1/J32.1)

Ethmoid sinusitis - causes pain between and/or behind eyes, headache (J01.2/J32.2)

Sphenoid sinusitis - causes less generalized pain, headache (J01.3/J32.3)

All forms of sinusitis may spread down towards the upper chest and cause increased coughing and trouble breathing.

Acute vs. chronic

Sinusitis can be acute (going on less than four weeks), subacute (4-8 weeks) or chronic (going on for 8 weeks or more).

All three types of sinusitis have similar symptoms, and are thus often difficult to distinguish.

Acute sinusitis

Acute sinusitis is often brought on by bacteria, such as Haemophilus influenzae, streptococci, or staphylococci.

It is usually precipitated by an earlier upper respiratory tract infection, generally of the viral type.

Chronic sinusitis

Chronic sinusitis is one of the most common complications of the common cold.

Symptoms include: Nasal congestion; facial pain; headache; fever; general malaise; thick green or yellow discharge; feeling of facial 'fullness' worsening on bending over; aching teeth.

In a small number of cases, chronic maxillary sinusitis can also be brought on by the spreading of bacteria from a dental infection. Chronic hyperplastic eosinophilic sinusitis is a noninfective form of chronic sinusitis.

Sinus headache

Sinus headache a headache caused by pressure within the sinus cavities of the head, usually in connection with infection of the sinuses. Signs and symptoms of sinus headache include pain and tenderness in the sinus area, discharge from the nose, and sometimes swelling of the face.

Diagnosis

Factors which may predispose to developing sinusitis include: allergies; structural problems such as, for example, a deviated septum, small sinus ostia; smoking; nasal polyps; carrying the cystic fibrosis gene (research is still tentative); prior bouts of sinusitis as each instance further narrows the drainage openings.

When imaging techniques are required for diagnosis CT scanning is the method of choice. If allergies are suspected, allergy testing may be performed.

Treatment

Therapeutic measures include simple painkillers (aspirin, paracetamol (acetaminophen) or similar), inhaling steam, nasal irrigation or jala neti using a warm saline solution, hot drinks including tea and chicken soup, over-the-counter decongestants, and getting plenty of rest. If sinusitis doesn't improve within 48 hours, or is causing significant pain, one should see a doctor, who may prescribe antibiotics or nasal steroids. If the recommended doses and duration of antibiotic treatment(s) are ineffective, one should consult a doctor; who may suggest further treatment by a qualified specialist.

If left untreated, sinusitis can lead to bronchitis and pneumonia.

For chronic or recurring sinusitis, referral to an otolaryngologist is indicated for more specialist assessment and treatment, which may include nasal surgery.

A recent advance in the treatment of sinusitis is a type of surgery called FESS - functional endoscopic sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis. This replaces the less effective Caldwell-Luc surgery.

Another recently developed treatment is balloon sinuplasty.

Recently, FDA Fast-Tracked a drug in Phase 3 clinical study for the treatment of Chronic Rhinosinusitis. Early tests at the Mayo Clinic showed substancial benifit to those treated in the study. A summary of the Mayo Clinic treatment is available here. Althought there are some licencing battles taking place over these drugs, they are currently available for other uses and therefore can be compounded by pharmacies or even by the patient.

External links

[Sinus Headache -Medterm.com]
[Sinus infection - MedicineNet.com].
[Acute sinusitis - MayoClinic.com], from the Web site of the Mayo Clinic.
[Chronic sinusitis - MayoClinic.com], from the Web site of the Mayo Clinic.
[Sinusitis - eMedicine.com], from the website of eMedicine.com.
[NIH]
[NHS Direct]

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