Inflammation of one or more sinuses is called sinusitis, which involves the maxillary, septal, frontal, and pterygoid sinuses, and it is a disease that has a high incidence in the population and affects the quality of life of patients. Sinusitis can be divided into 2 types: acute and chronic sinusitis. Acute sinusitis is mostly caused by upper respiratory tract infections and can be complicated by both bacterial and viral infections. Chronic sinusitis is more common than acute and often involves multiple sinuses at the same time.
A. Etiology of sinusitis
Sinusitis can be divided into 2 types of acute and chronic sinusitis. Acute sinusitis lasts <12 weeks and is characterized by persistent and severe symptoms of upper respiratory tract infection, including nasal congestion, pus, headache, etc. Chronic sinusitis has a duration of >12 weeks.
This disease is classified as mild and moderate/severe according to the visual analog scale (VAS) score (10 cm) of severity: mild = VAS 0-4 cm; moderate/severe = VAS 5-10 cm.
1.Acute sinusitis
Acute sinusitis is mostly caused by upper respiratory tract infections, and bacterial and viral infections can be concurrent. Common bacterial flora are Streptococcus pneumoniae, Streptococcus haemolyticus and Staphylococcus spp. and many other septic cocci, followed by Haemophilus influenzae and Cataplasma spp. Other pathogenic bacteria include streptococci, anaerobic bacteria and Staphylococcus aureus. Those caused by dental disease are mostly anaerobic infections, and the pus is often foul-smelling. Fungi and allergies may also be causative factors.
Acute sinusitis infection often comes from: sinus-derived infection, nasal-derived infection, neighboring tissue-derived infection, blood-derived infection, trauma-derived infection, as well as systemic and toxic factors.
2.Chronic sinusitis
Transformation from acute sinusitis: Mostly due to improper treatment of acute sinusitis, or not thoroughly treated so that recurrent episodes and delays do not heal, so that it becomes chronic. This is the primary cause of the disease.
Obstructive causes: obstructive diseases in the nasal cavity, such as nasal polyps, turbinate hypertrophy, nasal stones, nasal septum deviation, nasal tumors, nasal cavity filling and other obstruction of nasal cavity sinus ventilation and drainage, is an important cause of this disease.
The virulence of the causative bacteria: certain virulent causative bacteria, such as type B hemolytic streptococcus when suffering from scarlet fever, which cause acute sinusitis, are very easy to turn into chronic.
Odontogenic infection: Because the roots of the upper molars are adjacent to the bottom of the maxillary sinus, if the dental disease is not cured, it is easy to become odontogenic chronic maxillary sinusitis.
Trauma and foreign body: such as traumatic fracture, foreign body retention or clot infection, resulting in chronic sinusitis.
Sinus anatomical factors: Due to the special or abnormal anatomical configuration of each sinus, which is not conducive to ventilation and drainage, is also a self-factor that cannot be ignored.
Systemic factors: including various chronic diseases, malnutrition, low body resistance due to excessive fatigue. At the same time, there are various allergic factors and bronchial dilatation induced by the etiology.
Second, the clinical manifestations of sinusitis
1, acute sinusitis
Prevalent groups: all people are susceptible to occur, low age, old and frail people are more common.
The symptoms of the disease: systemic symptoms are often aggravated in the course of acute rhinitis on the affected side, followed by chills and fever, peripheral discomfort, mental discomfort, loss of appetite, etc. The systemic symptoms of acute odontogenic maxillary sinusitis are more dramatic. In children, the fever is higher and systemic symptoms such as convulsions, vomiting and diarrhea may occur in severe cases.
Local symptoms include nasal obstruction, which can occur as a result of congestion and swelling of the nasal mucosa and accumulation of secretions, and persistent nasal congestion on the affected side. Pus is present in the affected side of the nose, and a large amount of mucopurulent or purulent secretions are blown out, which may initially contain a little blood. Local pain and headache Acute sinusitis is often accompanied by a more intense headache in addition to inflammation leading to nasal pain, which is caused by swelling of the sinus cavity mucosa and pressure from secretion retention or negative pressure triggered by secretion evacuation, which stimulates the trigeminal nerve endings. Acute sinusitis pain has a regularity in its timing and location. The anterior group of sinuses is close to the surface of the skull and its headaches are mostly in the forehead, inner canthus and cheeks, while the posterior group of sinuses is deep in the skull and its headaches are mostly in the top of the head and posterior occipital region. Acute maxillary sinusitis: it often has pain in the forehead, cheek or upper molar, light in the morning and heavy in the afternoon. Acute frontal sinusitis is a huge pain in the forehead in the morning, gradually aggravated, reduced in the afternoon, and disappears completely in the evening. In septal sinusitis, the headache is mostly mild and limited to the inner canthus or the root of the nose, but may also radiate to the top of the head. Pterygoid sinusitis presents with pain deep in the eye, which may radiate to the top of the head, and may also present with an occipital headache that is light in the morning and heavy in the afternoon. However, some people have atypical pain symptoms and cannot identify the affected sinuses based solely on the characteristics of the headache and decreased sense of smell.
2.Chronic sinusitis
Prevalent groups: All populations are susceptible, more common in younger and older frail people.
Disease symptoms: local symptoms with pus, nasal discharge is mostly purulent or mucopurulent, yellow or yellow-green, the amount of variable, can flow backwards to the pharynx, unilateral with a foul smell, most often seen in odontogenic maxillary sinusitis or fungal infection.
Nasal congestion: varying in severity, mostly due to congestion and swelling of the nasal mucosa and increased secretions.
Olfactory disturbance: nasal congestion and inflammatory reaction can lead to olfactory disturbance.
Headache: Chronic sinusitis usually has no significant local pain or headache. If there is a headache, it often manifests as a dull pain or a feeling of heaviness in the head, heavy during the day and light at night. The anterior group of sinusitis mostly presents with swelling or dull pain in the forehead and nasal roots, while the headache in the posterior group of sinusitis is at the top of the head and back of the occipital region. When suffering from odontogenic maxillary sinusitis, it is often accompanied by ipsilateral upper row toothache.
Others: Due to the flow of pus into the pharynx and long-term breathing through the mouth, it is often accompanied by symptoms of chronic pharyngitis, such as sputum, foreign body sensation or dry and painful pharynx. If it affects the eustachian tube, there may also be symptoms such as tinnitus and deafness.
Other symptoms: pressure in the eyes may cause visual impairment, but it is rare. Heavy pressure in the head, or only dull pain or boring pain.
Systemic symptoms: The symptoms are mild or insignificant. Generally, there may be dizziness, easy fatigue, mental depression, depression, poor memory, insomnia, memory loss, poor concentration, and reduced work efficiency. Very few cases may have persistent low-grade fever if they have become focal.