Inflammation of one or more sinuses is called sinusitis, which involves the maxillary, septal, frontal and pterygoid sinuses, and is a disease with a high incidence in the population, affecting 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 the acute one and often involves multiple sinuses at the same time.
Disease classification
Sinusitis can be divided into 2 types: acute and chronic sinusitis. Acute sinusitis has a duration of <12 weeks and is characterized by persistent and severe symptoms of upper respiratory tract infection, including nasal congestion, pus, and headache. Chronic sinusitis has a duration of >12 weeks.
The disease is classified as mild and moderate/severe based on a visual analog scale (VAS) score (250px) of severity.
Mild = VAS 0-100px
Moderate/severe = VAS 5-250px
Acute sinusitis
Acute sinusitis is an acute purulent inflammation of the mucosa of the sinuses, often secondary to acute rhinitis.
Causes
Acute sinusitis is mostly caused by upper respiratory tract infections and can be complicated by both bacterial and viral infections. The common bacterial groups are Streptococcus pneumoniae, Streptococcus haemolyticus, and Staphylococcus spp. and, to a lesser extent, Haemophilus influenzae and Cataplasma spp. Other pathogenic bacteria include streptococci, anaerobic bacteria and Staphylococcus aureus. Most of the infections caused by dental disease are anaerobic, and the pus is often foul-smelling. Fungi and allergies may also be causative factors.
Acute sinusitis is often caused by: sinus-derived infection, nasal-derived infection, adjacent tissue-derived infection, hematogenous infection, trauma-derived infection, as well as systemic and toxic factors.
Diagnosis and Differentiation
Typical symptoms
Primary symptoms: nasal congestion with pus.
Secondary symptoms: head and face fullness and pressure sensation, altered sense of smell.
Disease treatment
1. Systemic treatment: Use sufficient amount of antibiotics to control the infection, as it is mostly coccus infection, penicillin and cephalosporins are the drugs of choice, and drug therapy emphasizes the selection of sensitive antibiotics and the use of sufficient amount and course of treatment. If the headache or local pain is severe, appropriate sedatives or analgesics can be used. The general treatment is the same as that for acute rhinitis. Chinese herbal medicine treatment is based on dispersing wind and heat, aromatizing the orifices, and supplemented by detoxification and removal of stasis.
2, improve sinus drainage: commonly used drugs containing 1% ephedrine nasal drops to contract the nasal cavity and improve drainage. Acute sinusitis can also reduce headache by changing the body position and thus improving the ventilation and drainage of the sinuses.
3, maxillary sinus puncture irrigation: acute maxillary sinusitis should be performed after the systemic symptoms have subsided and the local acute inflammation has been basically controlled. After irrigation, antibacterial solution can be injected 1-2 times a week.
4.Sinus replacement therapy: used in children with multiple groups of sinusitis.
5.If it is odontogenic maxillary sinusitis should be treated simultaneously with dental disease.
6.Mucus pro-discharge agent can be used to improve the nature of secretions and easy to discharge.
7.Nasal local hormone or systemic application of hormone can be applied to improve the local inflammatory state and enhance drainage.
8.Surgery: Acute sinusitis can be operated by nasal endoscopy when the drug control is unsatisfactory or complications arise, through endoscopic guidance to reach the lesion directly, open the sinus opening, remove the lesion, improve local drainage, and then restore the normal physiological function of the sinus.
Chronic sinusitis
Chronic sinusitis is a chronic purulent inflammation of the sinuses. It is more common than the acute one and often involves multiple sinuses at the same time.
Disease classification
1. Simple chronic sinusitis
Stage 1: solitary sinusitis.
Stage 2: multiple sinusitis.
Stage 3: whole group sinusitis.
2.Chronic sinusitis with nasal polyps
Stage 1: solitary sinusitis with solitary nasal polyp.
Stage 2: multiple sinusitis with multiple nasal polyps.
Stage 3: full group sinusitis with multiple nasal polyps.
3: multiple sinusitis or whole group sinusitis with multiple, recurrent nasal polyps and/or septal sinus osteophytes
Diagnostic Differentiation
Typical symptoms
Presence of symptoms for more than 12 weeks.
Primary symptom: nasal congestion.
Secondary symptoms: one or more of the following additional symptoms.
Yellow-green nasal discharge, head pain, impaired sense of smell.
Disease treatment
In a patient with diagnosed chronic sinusitis, the recommended treatment procedure should be: first medication (both topical and systemic applications), CT scan of the sinuses in case of ineffective medication, followed by nasal endoscopic surgery if there are imaging changes and indications for surgery.