Chronic Sinusitis

Chronic Sinusitis in General

Sinus infection lasting for months or years is called chronic sinusitis. Most important cause of chronic sinusitis is failure of acute infection to resolve.

Pathophysiology

Acute infection destroys normal ciliated epithelium impairing drainage from the sinus. Pooling and stagnation of secretions in the sinus invites infection. Persistence of infection causes mucosal changes, such as loss of cilia, oedema and polyp formation, thus continuing the vicious cycle.

Pathology

In chronic infections, process of destruction and attempts at healing proceed simultaneously. Sinus mucosa becomes thick and polypoidal (hypertrophic sinusitis) or undergoes atrophy (atrophic sinusitis). Surface epithelium may show desquamation, regeneration or metaplasia. Submucosa is infiltrated with lymphocytes and plasma cells and may show microabscesses, granulations, fibrosis or polyp formation.

Bacteriology


Mixed aerobic and anaerobic organisms are often present. Clinical Features
Clinical features are often vague and similar to those of acute sinusitis but of lesser severity. Purulent nasal discharge is the commonest complaint. Foul-smelling discharge suggests anaerobic infection. Local pain and headache are often not marked except in acute exacerbations. Some patients complain of nasal stuffiness and anosmia.

Diagnosis

1. X-ray of the involved sinus may show mucosalthickening or opacity.

2. X-rays after injection of contrast material may showsoft tissue changes in the sinus mucosa.

3. CT scan is particularly useful in ethmoid and sphenoidsinus infections and has replaced studies with contrastmaterials.
Treatment

It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation. A work-up for nasal allergy may be required. Culture and sensitivity of sinus discharge helps in the proper selection of an antibiotic.
Initial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics and sinus irrigations. More often, some form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases so as to provide wide drainage or to obliterate the sinus.

Recently, endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation. It also avoids external incisions.




Acute Tonsillitis