In sinusitis, we get inflammation of the paranasal sinuses → impaired drainage and build up of mucus.
We have 4 paranasal sinuses which are essentially air-filled extensions of the nasal cavity. They are lined with pseudostratified epithelium and also contain goblet cells which secrete mucous.
Their job is to:
- Decrease weight of the head
- Aid immune defence of the nasal cavity
- Humidify inspired air
- Increase resonance of the voice.
We have 4 paranasal sinuses bilaterally: frontal, ethmoid, maxillary, sphenoid sinuses.
We will discuss acute sinusitis (<12 weeks) and also chronic sinusitis (>12 weeks)…
Acute sinusitis is very common. It is usually viral in aetiology and is typically self-resolving.
🦠 Causative agents
- ⭐️ Rhinovirus is the most common agent.
If it lasts >10 days it is usually bacterial sinusitis due to:
- ⭐️ Strep. pneumoniae
- ⭐️ H. influenzae
- Moraxella catharhallis
- Strep. pyogenes
⚠️ Risk factors
- Smoking and smoking exposure
- Air pollution exposure
- Anatomical variations - septal deviation, nasal polyps, sinus hypoplasia.
- Asthma
- Diabetes mellitus
😷 Presentation
- Nasal discharge that is thick and purulent.
- Congestion
- Fever
- Facial pain that worsens when leaning forward.
- Olfactory changes
🔍 Investigations
It is predominantly a clinical diagnosis unless any complications are suspected, if complications are suspected, a CT scan will be considered.
🧰 Management
- Analgesia
- Nasal decongestants - should only be used for 1 week as it can cause a rebound congestion if used for too long.
However, if symptoms persist after 10 days, NICE recommends nasal corticosteroids, and if bacterial sinusitis is suspected we can give oral antibiotics;
- 🥇 Penicillin V - is first line
- 🥈 Co-amoxiclav is second line
- 🥇 Doxycycline - if the patient is penicillin allergic.
Chronic rhinosinusitis is when we have rhinitis/sinusitis that lasts >12 weeks.
🔍 Investigations
🏆 CT confirms diagnosis.
🧰 Management
Saline irrigation + intranasal corticosteroids.
Antihistamine:
- Benadryl - an H1 antagonist.
Lekotriene receptor antagonist:
- Montelukast
We can also do an endoscopic sinus surgery if refractory to any medical treatment.