What Is Acute Sinusitis?

Acute sinusitis is an acute purulent inflammation of the sinus mucosa, often secondary to acute rhinitis. Acute sinusitis is mostly caused by upper respiratory tract infections, and bacterial and viral infections can occur concurrently. All people are prone to acute sinusitis, and it is more common in young and old people. The disease affects patients' quality of life, may cause lower respiratory tract infections, and severe cases may cause orbital and intracranial complications.

Basic Information

Visiting department

ENT

Multiple groups

Young, old and infirm

Common causes

Upper respiratory tract infection

Common symptoms

Chills, fever, malaise, loss of energy, loss of appetite, etc.

Causes of Acute Sinusitis

Acute sinusitis is mostly caused by upper respiratory tract infections, and bacterial and viral infections can occur concurrently. Common bacterial flora are Streptococcus pneumoniae, Streptococcus hemolyticus, and Staphylococcus, which are a variety of pyogenic cocci, followed by Haemophilus influenzae and Moraxella catarrhalis, which are common in children. Other pathogenic bacteria include streptococci, anaerobic bacteria and Staphylococcus aureus. Caused by dental disease are mostly anaerobic infections, pus often with stench. Fungi and allergies may also be the cause.

Acute sinusitis infections often come from: sinus-derived infections, nasal-cavity infections, adjacent tissue-derived infections, blood-borne infections, trauma-derived infections, and systemic and toxic factors.

Clinical manifestations of acute sinusitis

1. good group

All populations are prone to occur, and younger, older and infirm are more common.

2. Symptoms of the disease

(1) Systemic symptoms often worsen during the course of acute rhinitis, followed by chills and fever, general discomfort, loss of energy, and loss of appetite. The systemic symptoms of acute odontogenic maxillary sinusitis are more dramatic. Children have high fever, and severe cases can cause systemic symptoms such as convulsions, vomiting and diarrhea.

(2) Local symptoms Nasal obstruction due to congestive swelling and accumulation of secretions in the nasal mucosa may cause persistent nasal congestion on the affected side. There are more mucopurulent or purulent secretions in the nose of the affected side of pus and snot. There may be a little blood in the nasal discharge at first, and those with odontogenic maxillary sinusitis have pus and odor. Local pain and headache Acute sinusitis is often accompanied by severe headaches in addition to nasal pain due to inflammation. This is caused by swelling of the sinus mucosa and pressure of secretion retention or emptying of secretions, which stimulates the trigeminal nerve endings. cause. Acute sinusitis pain has regularity in time and location. The sinuses in the anterior group are close to the skull surface, and the headaches are mostly in the forehead, palate, and cheeks. The sinuses in the posterior group are deep in the skull, and the headaches are mostly in the top of the head and posterior occipital. Acute maxillary sinusitis often causes pain in the forehead, cheeks, or upper molars. It is mild in the morning and heavy in the afternoon. Acute frontal sinusitis caused severe pain in the forehead from the morning, gradually aggravated, relieved in the afternoon, and disappeared in the evening. Ethmoid sinusitis usually has a milder headache and is confined to the inner condyle or the root of the nose. It may also radiate to the top of the head. Sphenoid sinusitis manifests as pain in the deep eyeballs, which can radiate to the top of the head, as well as pillow headaches that are mild in the morning and heavy in the afternoon. However, some people have atypical pain symptoms and cannot determine the affected sinuses based solely on the characteristics of the headache. Smell decreased .

(3) Disease hazard The disease affects patients' quality of life, may cause lower respiratory tract infections, and severe cases may cause orbital and intracranial complications.

Acute sinusitis examination

Nasal examination

The nasal mucosa is congested and swollen, especially in the middle turbinate, middle nasal passage and olfactory fissure. Sinusitis in the anterior group showed empyema in the middle nasal passages, and nasal sinus inflammation in the posterior group showed empyema in the olfactory fissure, or pus flowed from the top to the posterior nostril.

2. Auxiliary inspection

(1) Nasal endoscopy shows pus in the nasal cavity, and congestion and edema of the nasal mucosa.

(2) If the positional drainage is suspected of sinusitis, and no pus is found in the nasal passage, a positional drainage test is available to help diagnosis.

(3) X-ray nasal sinus radiography X-ray nasal condyle and nasal frontal radiographs are helpful for diagnosis. In the case of acute sinusitis, swelling of the sinus mucosa, turbidity of the sinus cavity, weakened light transmittance, and sometimes liquid level can be seen. Due to overlapping skulls, the observation effect is not good.

(4) CT of the sinuses showed the fluid level or soft tissue density in the sinuses. Because of its high resolution, CT is more detailed and comprehensive in observing lesions, which is a better indicator for the diagnosis of acute sinusitis.

(5) The nasal sinus T ₂ signal can be seen by MRI of the sinuses, which can be distinguished from the soft tissue shadow of the sinuses.

Diagnosis of acute sinusitis

Main symptoms

Stuffy nose, pus.

2. Secondary symptoms

The head and face are full and oppressive, and the sense of smell changes.

3. Signs

Local swelling and tenderness. Because the lesions in the former group are close to the skull surface, redness and swelling may occur on the skin and soft tissues of the affected area. As the inflammation spreads to the periosteum, the sinus cavity may have tenderness at the corresponding location on the surface. The posterior group of acute sinusitis was deep and had no redness or tenderness on the surface.

Diagnosis can be made based on typical symptoms and signs, and laboratory tests.

Differential diagnosis of acute sinusitis

It is mainly distinguished from other diseases that cause headaches, such as migraine and intracranial tumors; because of nasal congestion, it must be distinguished from nasal cavity and sinus tumors, such as nasal papilloma and nasal squamous cell carcinoma. The pathological diagnosis can be clear.

Complications of acute sinusitis

Eye complications

Orbital bone wall osteitis, periostitis, suborbital abscess, orbital cellulitis, intraorbital abscess, retrobulbar optic neuritis.

2. Intracranial complications

Epidural abscess, subdural abscess, suppurative meningitis, brain abscess, cavernous sinus thrombophlebitis.

Acute sinusitis treatment

Systemic treatment

Adequate antibiotics are used to control infections. Most of them are cocci infections. Penicillins and cephalosporins are the preferred drugs. Drug treatment emphasizes the selection of sensitive antibiotics and the use of adequate amounts and foot courses. If the headache or local pain is severe, sedatives or analgesics can be used appropriately. The general treatment is the same as for acute rhinitis. The traditional Chinese medicine treatment is mainly based on removing wind and clearing heat, fragrant Tongqiao, supplemented by detoxification and removing blood stasis.

2. Improve sinus drainage

Drugs containing 1% ephedrine are commonly used for nasal drips, to narrow the nasal cavity and improve drainage. Acute sinusitis can also reduce headaches by changing the position and improving ventilation and drainage of the sinuses.

3. Maxillary sinus puncture and irrigation

Acute maxillary sinusitis should be performed after systemic symptoms have subsided and local acute inflammation has been basically controlled. After rinsing, inject antibacterial solution once or twice a week.

4. Sinus Replacement Therapy

Used in children with multiple groups of sinusitis.

5. Dental Treatment

If it is odontogenic maxillary sinusitis, dental disease should be treated at the same time.

6. Mucus drainage promoting agent

Mucus excretion enhancers can be used to improve secretion properties and facilitate excretion.

7. Hormone therapy

Local hormonal or systemic hormonal can be applied to improve local inflammation and enhance drainage.

8. Surgery

Acute sinusitis can be treated with endoscopic sinus surgery when the drug control is unsatisfactory or complications occur. Endoscopy guides directly to the lesion, opens the mouth of the sinus, clears lesions, improves local drainage, and restores normal physiological functions of the sinuses.

Prognosis of acute sinusitis

Most acute sinusitis can be cured in a short period of time with reasonable medical treatment. In some cases, it can turn into chronic sinusitis and complications of the eyes or skull.

Acute sinusitis prevention

1. Strengthen physical exercise, enhance physical fitness, and prevent colds.

2. Acute rhinitis (cold) and dental disease should be actively treated.

3. Don't blow your nose hard when there is secretion in the nasal cavity, you should block the nostril on one side and clean the nasal secretion on the other side.

4. Timely and thorough treatment of acute inflammation of the nasal cavity and correction of anatomical deformities of the nasal cavity, treatment of chronic rhinitis and nasal septum deviation.

5. Avoid diving and snorkeling when swimming.

6. When suffering from acute rhinitis, it is not advisable to fly.

7. Properly treat allergic diseases and improve nasal cavity and sinus ventilation and drainage.

references:

1. Huang Xuanzhao, Wang Jibao. Practical Otolaryngology Head and Neck Surgery [M]. Beijing: People's Medical Publishing House, 2007: 151 170.

2. Xu Geng, Shi Jianbo, Wen Weiping, etc. Standardized diagnosis and treatment of sinusitis in children [J] .Chinese Otorhinolaryngology Head and Neck Surgery, 2005: 12 (7): 407 410.

3. Chinese Medical Association Otolaryngology Branch, Chinese Journal of Otolaryngology Editorial Board. Clinical classification and staging of chronic rhinosinusitis and nasal polyps and endoscopic sinus surgery evaluation criteria (1997 Haikou) [J]. Chinese Journal of Otorhinolaryngology, 1998: 33 (3): 134.