Infection of the lining of one or more sinuses around the nose and in the bones of the face, which sometimes arises from infection of the upper respiratory passages (eg common cold). It results in severe pain over the sinus, headache, and fever.
| ICD-9 | 473 |
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Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).
Classification
By location
There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. In addition to the acuity of disease, discussed below, sinusitis can be classified by the sinus cavity which it affects:
Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache) (J01.0/J32.0) Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity (located behind/above eyes), headache (J01.1/J32.1) Ethmoid sinusitis - can cause pain or pressure pain between and/or behind eyes, headache (J01.2/J32.2) Sphenoid sinusitis - can cause pain or pressure behind the eyes, but often refers to the vertex of the head(J01.3/J32.3)Recent theories of the sinusitis indicate that it often occurs as part of a spectrum of diseases that affect the respiratory tract (i.e. All forms of sinusitis may either result in, or be a part of, a generalized inflammation of the airway so other airway symptoms such as cough may be associated with it. chronic
Sinusitis can be acute (going on less than four weeks), subacute (4-12 weeks) or chronic (going on for 12 weeks or more).
All three types of sinusitis have similar symptoms, and are thus often difficult to distinguish.
Acute sinusitis
Acute sinusitis is often brought on by bacteria, most commonly Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. Acute episodes of sinusitis can also result from fungal invasion.
Chronic sinusitis
Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common.
Symptoms include: Nasal congestion;
In a small number of cases, chronic maxillary sinusitis can also be brought on by the spreading of bacteria from a dental infection.
Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. A task force for the American Academy of Otolaryngology - Head and Neck Surgery / Foundation along with the Sinus and Allergy Health Partnership broke Chronic Sinusitis into two main divisions, Chronic Sinusitis without polyps and Chronic Sinusitis with polyps (also often referred to as Chronic Hyperplastic Sinusitis.
A more recent, and still debated, development in chronic sinusitis is the role that fungus may play. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a definite factor in the development of chronic sinusitis and if it is, what the difference may be between those who develop the disease and those who do not.
Sinus headache vs migraine
Headache is rarely a symptom of sinusitis and a "sinus headache" is often a misdiagnosis of a migraine. Acute sinusitis can cause pressure within the sinus cavities of the head, but this always has associated pain to palpation of the sinus area and purulent greenish discharge from the nose.
It is also possible that chronic sinus inflammation may result in points of contact within the nasal cavity.
Diagnosis
Factors which may predispose to developing sinusitis include: allergies; prior bouts of sinusitis as each instance may result in increased inflammation of the nasal or sinus mucosa and potentially further narrow the openings.
When imaging techniques are required for diagnosis CT scanning is the method of choice.
Treatment
Therapeutic measures range from the medicinal to the traditional and may include nasal irrigation or jala neti using a warm saline solution, analgesics (such as aspirin, paracetamol (acetaminophen) or ibuprofen), hot drinks including tea and chicken soup, inhaling steam, over-the-counter decongestants and nasal sprays, and getting plenty of rest. If sinusitis doesn't improve within 48 hours, or is causing significant pain, one should see a doctor, who may prescribe antibiotics or nasal steroids.
For chronic or recurring sinusitis, referral to an otolaryngologist is indicated for more specialist assessment and treatment, which may include nasal surgery.
A relatively recent advance in the treatment of sinusitis is a type of surgery called FESS - functional endoscopic sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis.
Another recently developed treatment is Balloon Sinuplasty™.
Based on the recent theories on the role that fungus may play in the development of chronic sinusitis, newer medical therapies include topical nasal applications of antifungal agents.
Nasal irrigation and flush promotes sinus cavity health, and patients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge) and nasal congestion found nasal irrigation to be "just as effective at treating these symptoms as the drug therapies." In other studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis," and is "recommended as an effective adjunctive treatment of chronic sinonasal symptoms."
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