Chronic sinusitis

Defined as inflammation of mucosal lining of paranasal sinuses of more than 3 months duration Commonly follows a bout of acute sinusitis Mucous membrane of sinuses are damaged irreversibly Maxillary sinus is commonly involved

Aetiology

Acute sinusitis Chronic bronchitis Bronchiectasis Kartagener's syndrome Young's syndrome

Predisposing factors

Anatomical variations Congenital Hypersensitivity Dental sepsis Poor host resistance Allergy Iatrogenic – nasal packing, nasotracheal intubation

Pathological classification

Hypertrophic sinusitis (polypoidal sinusitis) Atrophic sinusitis (sclerosing / suppurative sinusitis) Papillary sinusitis / Hypertrophic sinusitis Follicular sinusitis – follicles are seen in the sinus mucosa Glandular sinusitis – glandular elements increase in the submucosal area of the sinus mucosa

Hypertrophic sinusitis

Inflammation mainly affects efferent vessels and lymphatics Soft tissues get affected secondarily Periphlebitis and perilymphangitis seen Polypoidal formation of mucosa occur due to repeated attacks Oedema of periosteum and rarefaction of bone is also seen

Atrophic sinusitis

Main changes occur in the afferent vessels Cellular reactions occur around arterioles and arteries Endarteritis is common Thrombus formation occur Atrophy of mucous membrane occurs

Papillary sinusitis

Main feature is the metaplasia of ciliated columnar epithelium into stratified squamous type This causes papillary hyperplasia of the epithelium Inflammatory cells are commonly seen Viral infections predominantly cause this type of infection

Clinical classification

Simple chronic infective sinusitis – Vasomotor and allergic components are absent. Usually follows attacks of acute sinusitis Mixed infective and vasomotor chronic sinusitis – is usually due to vasomotor rhinitis causing seconday infection in sinus mucosa Fungal sinusitis

Symptoms

Nasal symptoms Pharyngeal symptoms Ear symptoms Headache Eye symptoms Respiratory symptoms

Signs

Anterior rhinoscopy – red congested mucosa with purulent discharge from middle meatus Post nasal drip Granular pharyngitis

Investigations

Radiological Routine blood tests Pus for culture and sensitivity

Management

Medical Surgical

Medical management

Antibiotics Antihistamines Nasal decongestants Anti inflammatory drugs

Surgical managment

Antral wash Intranasal antrostomy FESS Caldwell Luc surgery External fronto ethmoidectomy Intranasal ethmoidectomy External ethmoidectomy

Complications

Orbital complications Mucocele / pyocele Fistulae Intracranial complications Osteomyelitis