CAUSES

The primary cause that leads to sinusitis is obstruction of the sinus openings. With this obstruction, blood circulation and ventilation of the sinus cavity are lower, leading to a drop in PO2 that favors bacterial growth. The infection can be acute, intermittent or chronic. The most common causes are bacteria, although rarely fungal and viral etiologies also cause sinusitis.

Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the bacteria found most frequently crops exudation (pus). Viral causes include rhinovirus, influenza virus type A and parainfluenza virus. In immunocompromised patients can cause infections of fungal sinusitis, as produced by Aspergillus fumigatus.

Acute sinusitis is usually preceded by a viral infection of the upper airway or associated with nasal polyps that have blocked effective drainage. Other factors associated with allergic rhinitis, sinusitis, vasomotor rhinitis, antibody deficiency syndromes, ciliary dysfunction, cystic fibrosis, foreign bodies and dental infections, etc.. …

SYMPTOMS

The most common symptoms of acute sinusitis are headache, mucopurulent discharge and fever. Other symptoms include epistaxis (nosebleeds), malaise, cough, hyposmia (absence of smell), pain on chewing and hoarseness. In children with chronic sinusitis, cough is the most common complaint, the fever is less common.

Patients with chronic sinusitis usually have purulent postnasal discharge, nasal congestion and headaches. Other symptoms are cough, rhinorrhea and chronic halitosis. The intense facial pain is an uncommon symptom in patients with chronic sinusitis. In some cases patients have no symptoms.

DIAGNOSIS

The history and physical examination are essential and can identify purulent sinusitis in 80% of cases. On clinical examination, nasal mucosa can be visualized red, swollen, purulent nasal secretion, associated with breast tenderness to pressure. By contrast, physical examination in chronic sinusitis may be normal or reveal nasal polyps or purulent nasal discharge. Radiographic imaging techniques such as sinus radiography and computed tomography (CT) should be reserved for difficult diagnostic problems and sinusitis unresponsive to antibiotics.

Computed tomography is useful for viewing the contents and the bony anatomy of the sinuses, especially if you suspect sphenoid and ethmoid sinusitis or neoplasm. In patients with recurrent sinusitis, consider allergic and nonallergic factors. In addition to the allergy skin tests are useful in quantitative determinations of immunoglobulin, the sweat chloride test and ciliary motility studies.

COMPLICATIONS

Since the introduction of antibiotics, serious complications of paranasal sinusitis are uncommon. These complications may include osteomyelitis of the frontal sinus, extradural subdural empyema and cavernous sinus thrombosis. Acute ethmoid sinusitis is more common in children than in adults and can cause swelling and unilateral orbital and periorbital cellulitis.

TREATMENT

The current medical therapy is aimed at treating the infection and achieve sinus drainage.

The antibiotics of choice for sinusitis, both acute and chronic, are ampicillin and amoxicillin, but producing bacteria B-lactamase are a constant problem.

Are valid alternatives-clavulámico amoxicillin, cefaclor, trimethoprim-sulfamethoxazole, cefuroxime, erythromycin and clindamycin-sulfizoxazol.

The duration of treatment of acute sinusitis should be at least ten to fourteen days, and chronic sinusitis in three-four weeks.

Supportive treatments to reduce tissue edema and relieve the obstruction of the sinus ostia include administration of oral decongestants and topical corticosteroids.

In patients with allergic rhinitis, the combination of decongestants and antihistamines can help reduce secretions. In some cases, topical nasal decongestants are used for two-three days, followed by topical nasal steroids, as the long-term topical decongestants may cause rhinitis medicamentosa. In some patients with significant nasal obstruction and nasal polyps, it requires a short course of prednisone seven-ten days.

Surgical consultation is required in cases of complicated acute sinusitis, sinusitis unresponsive to aggressive medical therapy and chronic recurrent sinusitis (more than four episodes per year). Surgical procedures should be followed by medical treatment, which involves the use of topical corticosteroids to minimize the recurrence of nasal polyps. Surgical interventions include sinus wash, creating a hole enlarged to provide effective drainage and aeration, and removal of diseased tissue.

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