Clinical features & mangement of chronic sinusitis

Chronic sinusitis is defined as chronic inflammation of mucosal lining of paranasal sinuses lasting for more than 3 weeks.

Pathology: The mucosal lining of para nasal sinuses shows evidence of chronic inflammatory changes. The cilia of the lining epithelium are damaged, causing inadequate drainage of sinus cavity. This is especially more common in maxillary sinuses. Pent up secretions start to accumulate within the sinuses. This retained secretions again predispose to secondary infections and reinfections causing a vicious cycle. There is also associated hypertrophy of the lining mucosa leading to polypoidal changes.

Clinical features:

Symptoms:

1. Nasal obstruction: This could be due to the result of underlying pathology like a deviated nasal septum / septal spur, polypoidal changes of nasal mucosa, hypertrophied turbinates. The patient infact complains of stuffy nose.

2. Nasal discharge:The patient complains of excessive nasal discharge, which could be mucoid to begin with and may later get purulent due to super added infections. This also leads to post nasal drip causing irritation of throat and formation of granular pharyngitis.

3. Abnormalities of smell: Patients may complain of diminished acuity of smell. Patient may also present with cacosmia or parosmia

4. Headache: is another important feature of chronic sinusitis. Pent up secretions within the sinus cavity leads to head ache.

5. Epistaxis:Hyperemia of nasal mucosa due to repeated infections may lead to epistaxis.

6. Sinus tenderness could also be present

Investigations:

Xray para nasal sinuses water's view - shows hazy sinuses

CT scan paranasal sinuses plain both axial and coronal cuts are diagnostic

Management:

Medical:

1. Antibiotics: Amoycillin is the drug of choice. Erythromycin can be considered in patients allergic to amoxycillin

2. Pain killers like acetaminophen can be used

3. Nasal decongestant drops like xylometazoline can be used

4. Antihistamines can be considered if allergy is suspected to be the cause

Surgical:

1. Antral lavage

2. Middle meatal antrostomy

3. FESS