RhinosinusitisRhinosinusitis 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 therapyNormal
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.
AntibioticAntibiotics
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 SinusitisA
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 SurgeryThe
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.
