Sinusitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Sinusitis is an inflammation of the paranasal sinuses, commonly caused by viral or bacterial infections, leading to nasal congestion, facial pain, and mucopurulent discharge.

Aetiology

  • Viral infections (most common): rhinovirus, influenza, parainfluenza.
  • Bacterial infections: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
  • Fungal infections: more common in immunocompromised individuals.
  • Allergic sinusitis: secondary to environmental allergens.

Pathophysiology

  • Inflammation of the sinus mucosa leads to mucosal swelling and obstruction of sinus drainage.
  • Accumulation of mucus provides an environment for bacterial proliferation.
  • Persistent inflammation can result in chronic sinusitis with mucosal thickening.

Risk Factors

  • Recent upper respiratory tract infection.
  • Allergic rhinitis.
  • Deviated nasal septum.
  • Smoking and exposure to pollutants.
  • Immunocompromised status (e.g., diabetes, HIV).

Signs and Symptoms

  • Nasal congestion: blockage or obstruction of airflow.
  • Facial pain or pressure: often localised to the affected sinus.
  • Mucopurulent nasal discharge: yellow or green nasal secretions.
  • Headache: worse with bending forward.
  • Postnasal drip: sensation of mucus drainage down the throat.
  • Fever: more common in bacterial sinusitis.

Investigations

  • Clinical diagnosis: based on characteristic symptoms.
  • Nasal endoscopy: for persistent or recurrent cases.
  • CT scan of sinuses: in cases of chronic or complicated sinusitis.
  • Microbial culture: if bacterial or fungal infection is suspected.
  • Allergy testing: if allergic sinusitis is suspected.

Management

1. Conservative Management:

  • Saline nasal irrigation: helps clear mucus and reduce inflammation.
  • Steam inhalation: may provide symptom relief.
  • Analgesia: paracetamol or ibuprofen for pain relief.

2. Medical Treatment:

  • Intranasal corticosteroids: fluticasone or mometasone for reducing inflammation.
  • Oral antihistamines: if allergic component suspected.
  • Antibiotics: only for suspected bacterial sinusitis (e.g., amoxicillin, Pen V or doxycycline).

3. Surgical Management:

  • Endoscopic sinus surgery: indicated for refractory or chronic sinusitis.

4. Referral:

  • ENT specialist: for persistent, recurrent, or complicated sinusitis.
  • Allergy specialist: if allergic rhinitis contributes to symptoms.
  • Immunology: if recurrent infections suggest an underlying immune deficiency.
Ear, nose and throat, ENTmypanotesSinusitis