Acute sinusitis is mostly secondary to acute rhinitis, which is an acute catarrhal or purulent inflammation of the mucous membrane of the sinuses, and in severe cases can involve the surrounding bone, surrounding soft tissues and organs, such as the orbit and the eye, causing serious complications.
I. Etiology
1.Systemic factors
Excessive fatigue, cold and humidity, malnutrition, vitamin deficiency, etc., cause a decrease in systemic resistance. Unclean living and working environment is the triggering factor. In addition, anemia, diabetes, hypothyroidism and other systemic diseases can also cause the disease; upper respiratory tract infectious diseases, such as influenza, measles, etc. can also trigger the disease.
2.Local factors
(1) nasal diseases: acute or chronic rhinitis, nasal septal deviation, turbinate hypertrophy, allergic rhinitis, nasal foreign bodies and tumors, etc., can block the sinus mouth nasal tract complex, impede sinus drainage and courage and sinusitis occurs.
(2) adjacent organs infection lesions tonsillitis, adenoid hypertrophy, etc., at the same time will be accompanied by nasal and nasopharyngeal inflammation, which in turn causes sinusitis. Periapical infection of the upper 2nd premolar, 1st and 2nd molar, plucking tooth damage to maxillary sinus, caries residue falling into maxillary sinus, etc. can cause maxillary sinusitis.
(3) Traumatic factors Traumatic fracture of the sinus or foreign body shot into the sinus, improper swimming and diving or improper blowing of the nose after swimming and sewage into the sinus can cause sinusitis.
(4) Medical factors: the nasal cavity filler left too long, continue bacterial infection caused by sinusitis.
(5) air pressure injury: high altitude flight or parachute jump, etc., negative pressure in the sinuses, can be the nasal cavity inflammatory material into the sinuses, causing aviation sinusitis.
The causative organisms are mostly septicoccus, hemolytic streptococcus, staphylococcus, and katococcus. This is followed by bacilli, such as H. influenzae, H. contortus, and E. coli. In addition, anaerobic bacteria are also more common, and mixed infections of the above bacteria can also occur.
II. Clinical manifestations.
1, systemic symptoms
Because sinusitis is often secondary to upper respiratory tract infections, such as acute rhinitis, etc.. Therefore, the patient’s original acute rhinitis symptoms will aggravate, and can appear chills, fever, loss of appetite, constipation, discomfort around the body. In children, dyspeptic symptoms such as vomiting, diarrhea, cough and lower respiratory symptoms may occur. In general, sinusitis should be considered when symptoms of nasal congestion and runny nose do not improve after more than 7 to 10 days. When repeated coughing, runny nose, and treatment according to bronchitis is not effective, you should also consider the possibility of coughing caused by backflow of nasal mucus to the pharynx during sinusitis.
2.Local symptoms
(1) Nasal congestion: Patients mostly have persistent unilateral or bilateral persistent nasal congestion, sometimes intermittent nasal congestion, which can cause open-mouth breathing when the nasal congestion is severe, caused by swelling of the nasal mucosa and accumulation of nasal mucus.
(2) Pus nasal discharge: a large amount of purulent or mucopurulent nasal discharge (yellow, yellow-green, or off-white pus, sometimes with odor) in the nasal cavity, which is difficult to blow out, and the pus may have a little blood in it. The pus flow backward to the throat or pharynx, causing itching, nausea, cough and sputum.
(3) Headache: mainly caused by purulent secretions, bacterial toxins and mucosal swelling stimulating compression of nerve endings. In maxillary sinusitis, the pain is mostly in the forehead or cheek, heavier in the morning and worse in the afternoon. In septal sinusitis, the headache is milder, mostly in front of both eyes or at the root of the nose, sometimes causing pain in the crown of the head, and partially manifesting as eye pain, pain behind the ear and occipital pain. In frontal sinusitis, the pain in the forehead starts in the morning after waking up, gradually worsens, starts to disappear in the afternoon, and then recurs the next day as a periodic forehead pain. In pterygoid sinusitis, the pain is mostly behind the eyes, dull pain, which can cause pain behind the ear and head, and sometimes causes pain in the occipital region.
(4) Hyposmia, mostly due to nasal congestion and pus nasal discharge obstructing the olfactory area, and gas cannot reach the olfactory area when breathing.
Diagnosis: Sinusitis should be suspected when there are symptoms of supraoperative, and CT examination of sinus can confirm the diagnosis (sinus CT is the gold standard for the diagnosis of sinusitis).
Treatment principles: root cause; control infection, promote nasal secretion discharge, restore nasal ventilation, and prevent complications.
1, appropriate rest, drink more water; adequate antibiotics to control infection; oral anti-allergy drugs and mucus pro-discharge agents.
2.Intranasal decongestant (no more than 7 days) or nasal sneezing hormone.
3, rest drainage Negative nasal pressure replacement, aspiration of sinus secretions or nasal flushing.