RECOGNITION AND MANAGEMENT OF SINUSITIS

Acute sinusitis frequently follows upper respiratory tract infections, Patients complain of headache, facial pain, fever and purulent rhinor rhoea. Diagnosis is based upon the symptoms, and treatment comprises s ymptomatic relief with analgesics, topical or systemic decongestants a nd steam inhalation, If indicated, antibiotics should be given for an adequate period of time, Patients with chronic sinusitis complain of a combination of nasal obstruction, rhinorrhoea and postnasal drip asso ciated with intermittent facial pain, with symptoms persisting for 3 m onths or more, Predisposition to the condition may be caused by rhinit is (allergic or nonallergic) and anatomical variants, Failure of mucoc iliary transport and sinus ostial obstruction leads to mucosal oedema, mucous hypersecretion and chronic infection, Current treatment aims a re to control rhinitis and improve ventilation and function of the sin uses, Rhinitis may be controlled with the long term use of topical cor ticosteroids, mast cell stabilisers or antihistamines, either alone or in combination. Secretions may be cleared with steam inhalation and/o r saline nasal douching. Failure to control chronic sinusitis with med ical treatment may indicate surgery. The aim of surgery is to improve ventilation and facilitate drainage of the sinuses, allowing the resto ration of normal function. Removal of nasal polyps, reduction of infer ior turbinates or septal straightening may be all that is required. So me patients will need endoscopic ethmoidectomy and middle meatal antro stomy. Improved ventilation in the ethmoid infundibulum may help to re solve disease in the maxillary and frontal sinuses. Medical treatment of underlying rhinitis will need to be continued postoperatively, ofte n in the long term, while special consideration needs to be paid to si nusitis in children, in relation to dental disease and in the immunosu ppressed. Complications of acute and chronic sinusitis include intraor bital and intracranial sepsis. These potentially lethal complications need urgent evaluation with high resolution computerised tomography (C T) scanning, intravenous administration of broad spectrum antibiotics (including anaerobic and microaerophilic cover) and urgent surgical dr ainage as appropriate.