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The paranasal sinuses are commonly the seat of acute or chronic inflammation. Anatomical abnormalities interfering with the normal draining mechanisms predispose to infection. Infection reaches the sinuses from the nose, mouth, tonsils, nasopharynx, and the upper canines or molars. The bacterial flora are often mixed, including streptococci, staphylococci, pneumococci, Klebsiella, E.Coli and anaerobes. The lining mucosa is inflamed and the sinus may be filled with pus.
Clinical features
Acute sinusitis starts with headaches, fever, rigor and chills. Tenderness may be elicited over the sinuses. Pus may be seen pouring from the opening of the affected sinus on speculum examination. The condition tends to become chronic if not properly treated.
Chronic sinusitis leads to recurrent headache, which shows a diurnal periodicity- the headache starting in the morning and worsening by mid-day, to subside by evening. Foul- smelling purulent nasal discharge may occur. Once established, the condition persists for months or even years. Infection may spread to cause meningitis, thrombophlebitis of the intracranial veins, thrombosis of the cavernous sinus and sagittal sinus, and extradural abscesses. Aspiration of pus into the respiratory tract leads to recurrent bronchitis, aspiration pneumonia, bronchiectasis, and lung abscess. Infection of the ethmoid sinus may lead to third nerve palsy or spread to the orbit to produce orbital cellulites and painful exophthalmos. Frontal sinusitis may lead to osteomyelitis of the frontal bone and edema over this region (Pott's puffy turmor).
Diagnosis
Sinusitis should be suspected from the history of chronic headache and the demonstration of purulent discharge from the nose. X-ray examination of the skull shows opacity over the affected sinuses.
Treatment
Specific therapy is to administer antibiotics depending on bacteriological results. In the acute stage, penicillin is effective in usual dosage. Decongestant nasal drops and steam inhalations help in reducing nasal mucosal edema and thus favor drainage of pus. Aspirin gives symptomatic relief. In chronic sinusitis, if conservative measures fail to clear the infection, pus has to be removed by puncture and wash out.
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