Title : Sinus Infection [Sinusitus]
link : Sinus Infection [Sinusitus]
Sinus Infection [Sinusitus]
Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the sinuses resulting in symptoms. Common signs and symptoms include thick nasal mucus, a plugged nose, and pain in the face. Other signs and symptoms may include fever, headaches, poor sense of smell, sore throat, and cough. The cough is often worse at night. Serious complications are rare. It is defined as acuterhinosinusitis (ARS) if it lasts less than 4 weeks, and as chronic rhinosinusitis (CRS) if it lasts for more than 12 weeks.
It can be due to infection, allergies, air pollution, or structural problems in the nose. Most cases are due to a viral infection. A bacterial infectionmay be present if symptoms last more than ten days or if a person worsens after starting to improve. Recurrent episodes are more likely in people with asthma, cystic fibrosis, and poor immune function.
Some cases may be prevented by hand washing, avoiding smoking, and immunization.Pain killers such as naproxen, nasal steroids, andnasal irrigation may be used to help with symptoms.
Sinusitis is a common condition. It affects about between 10% and 30% of people each year in the United States and Europe. Women are more often affected than men.
Sinusitis is a common condition, with between 24–31 million cases occurring in the United States annually.Chronic sinusitis affects approximately 12.5% of people.
Signs and symptons:
Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. This pain is typically localized to the involved sinus and may worsen when the affected person bends over or when lying down. Pain often starts on one side of the head and progresses to both sides.
Sinus infections can also cause middle ear problems due to the congestion of the nasal passages. This can be demonstrated by dizziness, “a pressurized or heavy head”, or vibrating sensations in the head. Post-nasal drip is also a symptom of chronic rhinosinusitis.
A study suggested that up to 90% of “sinus headaches” are actually migraines.People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.
By location-
- Maxillary – can cause pain or pressure in the maxillary (cheek) area (e.g.,toothache, or headache).
- Frontal – can cause pain or pressure in the frontal sinus cavity (located above eyes), headache, particularly in the forehead.
- Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose (the medial canthi), and headaches.
- Sphenoidal – can cause pain or pressure behind the eyes, but often refers to the skull vertex (top of the head), over the mastoid processes, or the back of the head.
Complication-
The proximity of the brain to the sinuses makes the most dangerous complication of sinusitis, particularly involving the frontal and sphenoid sinuses, infection of the brain by the invasion of anaerobic bacteria through the bones or blood vessels. Abscesses, meningitis and other life-threatening conditions may result. In extreme cases the patient may experience mild personality changes, headache, altered consciousness, visual problems, seizures, coma and possibly death.
| Stage | Description |
|---|---|
| I | Preseptal cellulitis |
| II | Orbital cellulitis |
| III | Subperiosteal abscess |
| IV | Orbital abscess |
| V | Cavernous sinus septic thrombosis |
The diagnosis of these complication can be assisted by noting local tenderness and dull pain, and can be confirmed by CT and nuclear isotope scanning. The most common microbial causes are anaerobic bacteria and S. aureus. Treatment includes performing surgical drainage and administration of antimicrobial therapy. Surgical debridement is rarely required after an extended course of parenteral antimicrobial therapy. Antibiotics should be administered for at least 6 weeks. Continuous monitoring of patients for possible intracranial complication is advised.
Diagnosis :
Acute – Health care providers distinguish bacterial and viral sinusitis by watchful waiting. If a person has had sinusitis for fewer than 10 days without the symptoms becoming worse, then the infection is presumed to be viral. When symptoms last more than 10 days or get worse in that time, then the infection is considered bacterial sinusitis. Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa.
Chronic- For sinusitis lasting more than 12 weeks a CT scan (computed tomography) is recommended.
Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps. In rare cases, sinusoscopy may be made.
Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses. This is generally a completely painless (although uncomfortable) procedure which takes between five and ten minutes to complete.
Treatment :
Recommended treatments for most cases of sinusitis include rest and drinking enough water to thin the mucus. Antibiotics are not recommended for most cases.Breathing low-temperature steam such as from a hot shower or gargling can relieve symptoms.
Antibiotics – Most sinusitis cases are caused by viruses and resolve without antibiotics. However, if symptoms do not resolve within 10 days, amoxicillin is a reasonable antibiotic to use first for treatmentwith amoxicillin/clavulanate being indicated when the person’s symptoms do not improve after 7 days on amoxicillin alone. Antibiotics are specifically not recommended in those with mild / moderate disease during the first week of infection due to risk of adverse effects,antibiotic resistance, and cost. The guidelines also recommend against other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim/sulfamethoxazole, because of growing drug resistance. The FDA recommends against the use of fluoroquinolones when other options are available due to higher risks of serious side effects.
Corticosteroids- For cases confirmed by radiology or nasal endoscopy, treatment with corticosteroids alone or in combination with antibiotics is supported. The benefit, however, is small.There is only limited evidence to support short treatment with oral corticosteroids for chronic rhinosinusitis with nasal polyps
Surgery- For chronic or recurring sinusitis, referral to an otolaryngologist may be indicated, and treatment options may include nasal surgery. Surgery should only be considered for those people who do not benefit with medication.A number of surgical approaches can be used to access the sinuses and these have generally shifted from external/extranasal approaches to intranasal endoscopic ones. The benefit of Functional Endoscopic Sinus Surgery (FESS) is its ability to allow for a more targeted approach to the affected sinuses, reducing tissue disruption, and minimizing post-operative complications.The use of drug eluting stents such as propel mometasone furoate implant may help in recovery after surgery.
Another recently developed treatment is balloon sinuplasty. This method, similar to balloon angioplasty used to “unclog” arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner.
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