Sinusitis 

Sinusitis is inflammation of the mucous membrane lining the paranasal sinuses.

Rhinosinusitis is inflammation of the mucous membranes of the nose and paranasal sinuses.

Depending on the location of the inflammation, the following types are distinguished:

inflammation of the mucous membrane of the maxillary sinus – maxillary sinusitis (antritis)

inflammation of the mucous membrane of the ethmoid air cells – ethmoiditis

inflammation of the mucous membrane of the frontal sinus – frontal sinusitis

inflammation of the mucous membrane of the sphenoid sinus – sphenoiditis.

If the inflammatory process spreads to all sinuses on one side of the face, the condition is called hemisinusitis; if it affects both sides, it is called pansinusitis.

Depending on its course, sinusitis may be acute or chronic.

Inflammation of the maxillary sinus (maxillary sinusitis) occurs most commonly.

Paranasal sinus disease is rarely confined to a single sinus.

Acute rhinosinusitis most commonly develops as a complication of an acute respiratory viral infection (from 20% to 80%).

Acute sinus inflammation is caused by bacterial microorganisms. Contributing factors include hypothermia, trauma, abnormalities in the nasopharyngeal area, deformity of the nasal bony framework, dental decay, tumors, allergies, and smoking.

Symptoms:

General symptoms include feeling unwell and an elevated body temperature. Local symptoms include difficulty breathing through the nose, nasal discharge, and a feeling of pressure and pain in the area of the affected sinus. The pain may be severe and radiate to the teeth, eye, and forehead on the affected side. Pain at the back of the head is characteristic of sphenoid sinusitis. Pain may intensify when the head is tilted downward. In some cases, a reduced or complete loss of smell, tearing, and sensitivity to light may occur.

When examining a patient with rhinosinusitis, swelling of the cheek or eyelids may sometimes be detected (if orbital complications develop).

Anterior rhinoscopy or endoscopic examination of the nose: 

The physician assesses the condition of the nasal mucosa, the presence or absence of abnormal discharge, where it may be originating from, and other factors contributing to the pathological process.

Additional tests are required to confirm the diagnosis: X-ray imaging of the paranasal sinuses (computed tomography is preferable) and laboratory blood tests.

Depending on the stage of the disease and the extent of the inflammatory process, medical treatment may include antibiotic therapy, nonsteroidal anti-inflammatory and anti-edema medications, and topical vasoconstrictors.

Maxillary sinus puncture is performed to identify and evacuate its contents, assess the functional condition of the sinus’s natural drainage opening, and administer medications into the sinus. The procedure is performed using a special needle inserted through the lower nasal passage after prior anesthesia and decongestion of the middle nasal passage. Antibiotic and glucocorticosteroid solutions are administered into the sinus during the puncture.

Rhinogenic orbital or intracranial complications are indications for emergency surgery. Surgical treatment is also indicated for patients with odontogenic maxillary sinusitis or chronic sinusitis in general.

One of the main causes of chronic inflammation of the paranasal sinuses is generally considered to be inadequately treated acute sinusitis.

Chronic sinusitis develops in the setting of secondary immunodeficiency as a result of a prolonged disease course, reduced immune reactivity, and anatomical abnormalities that impair ventilation of the affected sinus.

Chronic sinusitis is characterized by a wide variety of morphological changes corresponding to the clinical forms of the disease.

Lviv Medical Center provides diagnosis and treatment of acute and chronic rhinosinusitis.