Acute sinusitis is mostly an infection of the sinus mucosa accompanied by an upper respiratory tract infection, which is an infectious inflammation caused directly by bacteria. Clinically, the systemic symptoms are irritability, chills, fever, headache, depression and drowsiness; the local symptoms are often nasal congestion, runny nose, olfactory disturbance, local pain or headache. Unless orbital and cranial complications occur, surgery will be used in due course. Acute sinusitis is mainly treated thoroughly with drugs, nasal wash and negative pressure replacement to prevent migration to chronic sinusitis.
Chief complaint.
Female, 8 years old. She has been suffering from “nasal congestion and headache with fever for 4 days.
Etiology.
Sinus mucosal infection accompanied by an upper respiratory tract infection is an infectious inflammation caused directly by bacteria.
(1) Bacterial infections: The pathogenic bacteria that cause upper respiratory tract infections can lead to sinusitis, the most common pathogenic bacteria are Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, accounting for about 80%. Anaerobic bacteria are also not uncommon; mixed infections are far more common than single bacterial infections.
(2) Infection of neighboring organs: The 2nd bicuspids and 1st and 2nd molars of the upper row are adjacent to the bottom wall of the maxillary sinus, which often leads to odontogenic maxillary sinus inflammation due to apical infection or injury during tooth extraction; in addition, adenoid hypertrophy, adenoiditis and tonsillitis can be affected and secondary to sinusitis.
(3) External infections: trauma, such as fractures, submucosal hematomas, mucosal contusions and foreign body residues; intranasal obstruction, such as long placement of fillings, nasal stones or tumors; swimming infections, sinus pneumatic injuries, etc. can directly or indirectly induce the occurrence of acute inflammation of the sinuses.
Pathology.
The pathological changes of sinusitis are closely related to the type of pathogenic bacteria, virulence and antibiotic resistance, such as Streptococcus pneumoniae which mostly causes cicatricial inflammation, is not easy to septicize, does not invade the bone wall, and is easier to treat. Batcher’s study showed that in the pathogenesis of acute sinusitis, inflammatory cells and epithelial cells upregulate the expression of inflammatory cytokines through NF-Kb activation, with neutrophil chemotaxis as the main inflammatory pathway. The main inflammatory substances and cytokines involved are tumor necrosis factor, IL-1,6,8.
Clinical manifestations.
Systemic symptoms and local symptoms persist for up to 12 weeks.
1. systemic symptoms: acute sinusitis may be accompanied by irritability, chills, fever, headache, mental depression and drowsiness.
2.Local symptoms.
(1) Nasal congestion: one of the most common symptoms, mainly caused by acute congestion and swelling of the mucous membrane and accumulation of secretions in the nasal cavity; ventilation can be improved after removing the secretions.
(2) Pus flow: the amount and nature of nasal secretions depend on the severity of the lesion, and the secretions are mostly purulent draining from the middle nasal passage to the anterior and posterior nostrils (Figure 1-9-1).
(3) Olfactory disturbance: Most of them are temporary, mainly due to the accumulation of purulent secretions in the olfactory fissure or the inflammatory edema of the mucous membrane in the olfactory area caused by irritation or the inability of the olfactory area to be reached by airflow due to mucosal swelling.
(4) Local pain or headache: more or less local heavy and painful sensation, mostly aggravated when the venous pressure in the head is increased by lowering the head, coughing, exerting, etc., or when emotionally excited. The pain caused by each sinus in acute sinusitis has its own characteristics.
Acute maxillary sinusitis: the pain is mostly located at the anterior wall of maxillary sinus – the fossa of the cuspids, and can be reflected to the frontal area, and the pain at the alveolar area; the pain is regular, mostly not obvious in the morning, and then gradually aggravated to the most obvious in the afternoon.
Acute frontal sinusitis: the pain in the forehead is obvious and periodic, i.e., it is obvious in the morning, gradually aggravated, most obvious at noon, gradually reduced in the afternoon, and can be completely relieved at night.
Acute septal sinusitis: pain at the inner canthus or nasal root can be felt to a lesser degree, apparent in the morning and relieved in the afternoon.
Acute pterygoid sinusitis: the pain localization is deeper and more inaccurate, mostly dull pain behind the eye or behind the occiput, but sometimes it can cause widespread reflex pain, such as involving the trigeminal nerve, which often causes nausea symptoms. The pain is also mostly light in the morning and heavy in the afternoon.
Sinusitis headache often has the following characteristics: ① accompanied by symptoms such as nasal congestion, runny nose and loss of smell; ② more temporal or fixed site, mostly heavy during the day, light at night, and often on one side, such as bilateral must be heavier on one side; the former group of sinusitis more in the forehead pain, the latter group of sinusitis more in the occipital pain; ③ rest, nasal drops, steam inhalation or drainage improvement, nasal ventilation after the headache is reduced. The headache is aggravated by coughing, low head position or exertion due to the increase of venous pressure in the head. The headache is also aggravated by smoking, drinking alcohol and emotional excitement.
3. Physical signs.
Anterior rhinoscopy or nasal endoscopy commonly reveals the following lesions.
Swollen turbinates: acute congestion and swelling of the nasal mucosa, narrowing of the middle nasal passage.
Purulent nasal discharge: Purulent secretions accumulate in the middle nasal tract, nasal floor, pterygoid septal fossa and olfactory fissure area.
Local pressure and percussion pain: pronounced at the involved sinus walls.
Treatment.
1. Medication: Unless surgical treatment is used in due course when orbital and cranial complications occur, acute sinusitis is mainly treated with medication. The following types of drugs are mainly used.
2. Antibiotics: For common pathogenic bacteria in the upper respiratory tract, the preferred drug recommended by the Centers for Disease Control is systemic amoxicillin + potassium clavulanate, a second-generation cephalosporin antibiotic. The duration of use is about 2 weeks. Topical antibiotic flushing has no therapeutic effect.
3, local glucocorticoids: the most important local anti-inflammatory drugs, recent studies have shown that the effect of using local glucocorticoids alone is better than that of using amoxicillin alone, whether to control the overall symptoms or local symptoms of the nose. The combination of the two can improve the efficacy and shorten the course of the disease. The duration of use is within 12 weeks.
4.Mucus promoter: It has the effect of diluting mucus and promoting cilia activity, and the duration of use is less than 12 weeks.
5.Other treatments.
(1) negative pressure replacement therapy: simple, easy and effective, especially for children, can improve the symptoms.
(2) sinus puncture rinse: mostly used for the treatment of maxillary sinusitis.
(3) nasal lavage: can improve the symptoms.