Google Jun 13, 2009 | Web Health Directory

13 June, 2009

CHRONIC SINUSITIS

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Sinus infection lasting for months or years is called chronic sinusitis.Majority of the cases of acute sinusitis occurs due to failure of the acute infection to resolve.

Acute infection of the sinuses lead to destruction of the normal ciliated epithelium of the sinuses[ciliated epithelium is a special type of lining epithelium formed of a lining of cells,which possesses hair like structures called cilia,these structures help in gradual removal of the secretions within the sinuses.]Destruction of the ciliated epithelium leads to impairment of the sinus drainage,which in turn leads to pooling of secretion within the sinuses.Persistence of infection leads to some changes to the epithelium like edema,loss of cilia,polyp formation etc.

Clinical features ere somewhat vague.Symptoms are similar to acute sinusitis,but of lesser intensity.Usually the presenting sign is purulent nasal discharge.Local pain and headache may occur,but are usually not as severe acute sinusitis except in cases of acute exacerbation of chronic sinusitis.Some patients may also complain of anosmia,nasal stuffiness.

For establishing a clinical diagnosis of sinusitis some investigations like X-ray of the para nasal sinuses,CT scan of the para nasal sinuses may be done.CT scan is very useful for sinusitis of sphenoid and ethmoid sinuses.CT scan shows the mucosal details very clearly.Some specialists also perform aspiration and irrigation of the sinuses.Finding of pus in aspirate is confirmatory.

For proper management of chronic sinusitis,it is imperative to know the exact cause of obstruction of sinus drainage and ventilation.culture and sensitivity test of the sinus discharge,helps in proper selection of an antibiotic.A work up of nasal allergy may be required.

Initial treatment of chronic sinusitis usually is conservative consisting of an antibiotic,anti-histaminic,decongestant etc.In our set-up as an empirical antibiotic,we usually use amoxycillin or amoxy-clavulinic acid combination in cases of serious infections.

More often than not some form of surgery is required to establish free drainage and ventilation of the sinuses and to remove the irreversible disease.Recently funtional endoscopic sinus surgery[surgeries of the sinuses done with the help of various types of endoscopes and monitors in which the nasal cavity and sinuses can be visualised] have replaced radical surgeries.

amoxycillin



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