Sinusitis

This is an inflammation of the membranous lining of one or more of the sinuses. Sinusitis is also referred to as rhinosinusitis because inflammation of the nasal mucosa generally accompanies sinusitis

Factors predisposing to sinus membrane inflammation

  • Upper respiratory tract infection.
  • Allergy.
  • Asthma.
  • Smoking.
  • Hormonal status (eg, pregnancy).
  • Nasal dryness.
  • Diabetes mellitus.
  • Presence of a foreign body.
  • Inhalation of irritants (eg, cocaine).
  • Iatrogenic (eg, nasogastric tubes, mechanical ventilation).
  • Dental problems (eg, trauma, infection).
  • Some sporting activities (eg, swimming, diving, high-altitude climbing).
  • Mechanical obstruction (eg, normal anatomical variations, nasal polyps).
  • Previous history of trauma (nose, cheeks).
  • Immunocompromise.

Symptoms

Sinusitis usually occurs after an upper respiratory tract infection, such as a old. If you have a persistent cold and develop the symptoms below, you may have sinusitis.

Symptoms of sinusitis include:

  • a green or yellow discharge from your nose
  • a blocked nose
  • pain and tenderness around your cheeks, eyes or forehead
  • a sinus headache
  • a high temperature (fever) of 38C (100.4F) or more
  • toothache
  • a reduced sense of smell
  • bad breath (halitosis)

Diagnosis

Acute sinusitis is diagnosed if there is:

  • Facial discomfort (eg, a feeling of congestion or fullness, often unilateral and worse when bending forwards) or pain.
  • Nasal obstruction or (purulent) nasal discharge or postnasal drip.
  • Decreased or absent sense of smell.

This may be accompanied by:

  • Headache
  • Halitosis
  • Fatigue
  • Dental pain.
  • Cough
  • A feeling of pressure or fullness in the ears.

In children, symptoms of rhinitis predominate ± the additional feature of ear discomfort due to the blockage of the Eustachian tube.

Management

Helpful measures to relieve symptoms include

  • Paracetamol/ibuprofen for pain/fever.
  • Intranasal decongestant (oral is not recommended for sinusitis) for a maximum of a week.
  • Nasal irrigation with warm saline solution.
  • Warm face packs, which may provide localised pain relief.
  • Adequate fluids and rest.
  • Antibiotics are reserved for severe or prolonged infections.

Complications

They occur more commonly in children. They include orbital cellulitis,meningitis brain abscess, osteomyelitis and cavernous sinus thrombosis

Prognosis

Symptoms are likely to be relatively slow to resolve (2-3 weeks, regardless of whether antibiotics are taken or not) but over two thirds of patients experience improvement or resolution of symptoms without antibiotic treatment.

 

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