Rhinosinusitis
Rhinosinusitis is defined as inflammation of the nose and the paranasal
sinuses. The symptoms include nasal blockage, loss of smell, nasal
discharge, postnasal drip and facial pain. It is defined as acute
sinusitis if complete resolution of symptoms is achieved within 12
weeks. If the symptoms persist more than 12 weeks, it is defined as
chronic sinusitis.
Examination for sinusitis must include nasoendoscopy. This procedure is
performed by ENT specialists under local anaesthesia. The abnormalities
include mucopurulent nasal discharge, the mucosal edema with total
obliteration of the sinus outlet and nasal polyps will be detected.
Besides, the anatomy of the nasal cavity and sinus outlet can also be
seen.
CT scan of the paranasal sinuses is useful for assessment of sinusitis.
It can detect mucosal changes within ostiomeatal complex and/or sinuses
and also opacity of the sinuses and delineate the anatomy of the
sinuses.
Treatment of Acute Sinusitis
Symptomatic therapy
Normal saline lavage is used to remove secretions and promote nasal
mucosal healing. Oral and topical decongestants can reduce mucosa
congestion and improve drainage. Mucolytic is used to thin mucus
secretions, reduce mucus stasis, and promote clearing. Antihistamine can
decrease mucus production and diminish nasal discharge. Intranasal
corticosteroid is also used to reduce inflammation and improve
associated symptoms.
Antibiotic
Antibiotics are a common prescription for acute rhinosinusitis. However,
only 0.2%-2% of viral upper respiratory tract infections are
complicated by bacterial rhinosinusitis and around 40% of acute
bacterial infections resolve spontaneously. That means 85%-98% of
patients with acute rhinosinusitis are needlessly prescribed an
antibiotic
Early treatment of rhinosinusitis should be focused on control
inflammation to allow sinus drainage and prevent bacterial infection.
Antibiotic should be reserved for persistent moderate to severe disease
and complications.
Treatment of Chronic Sinusitis
A careful history taking and past medical records review are important. A
thorough physical examination including fiberoptic nasoendosocpy is
necessary to delineate the patient's anatomy. CT scan of paranasal sinus
will help document the extent of disease and clarify any other anatomic
abnormalities.
An optimal medical treatment consists of antibiotic, nasal saline
irrigation, intranasal steroid spray should be given. The patient should
then be re-evaluated and restaged in 1 month. If the patent is not
responsive to the treatment, surgical intervention should be considered.
Endoscopic Sinus Surgery
The surgery is done under general anaesthesia. The sinus opening will be
widened with all the obstruction removed. The sinuses will be cleansed
with the mucopus drained. The normal mucus clearance mechanism will be
restored. The operation is performed inside the nose under endoscopic
control with no external surgical scar. In certain situation, it will
combine with other nasal surgeries (such as septoplasty or polypectomy)
to improve the access of the surgical field and the ventilation of the
sinuses.
Postoperatively, the nose will be packed with dressing for hemostasis.
The dressing will be removed in 1 to 2 days. Nasal saline irrigation
should be started after the removal of nasal packing.
The complications include bleeding and infection which is not common. Rare complications include brain and eye injury.
Reference: http://www.ent-hk.com/
It
is not intended as medical advice to any specific person. If you have
any need for personal advice or have any questions regarding your
health, please consult your ENT doctor for diagnosis and treatment.
