Thursday, February 28, 2013
Sinusitis is an important public health problem, which has a growing incidence and prevalence in developed countries. Sinusitis is an inflammation of the nasal mucous membrane covering the nose and paranasal sinuses.
Although traditionally is only called sinusitis, this inflammatory process is often preceded by rhinitis. Then expands and to mucosa paranasal sinuses , which is why recommend it using of the rhino-sinusitis term .
Signs and symptoms
Major criteria by which is diagnosed are:
Pressure and facial pain (suggestive of rhino-sinusitis, only associate with other major criterion), nasal obstruction, nasal discharge / pus drip, Disorders of smell (hyposmia / anosmia) Fever (acute rhinosinusitis only). Minor criteria consist of headache, fetid halitosis, fatigue, coughing, and accusing ear (otalgia, autofonie, tinnitus).
In acute rhinosinusitis the fever, facial pressure isolated are not elements of positive diagnosis in the absence of other signs or symptoms nose. Diagnosis of acute bacterial rhinosinusitis is established if symptoms of a viral infection worsens after 5 days, if symptoms persist after 10 days of onset of symptoms or the presence particularly pronounced for typical viral infection. Subacute rhinosinusitis shows complete revolution after effective medical treatment. In chronic rhinosinusitis the facial pain is not a symptom suggestive in the absence of other signs or symptoms nose. No sign or symptom is not specific and sensitive for the diagnosis of rinosinuzitei exactly.
How diagnose rhinosinusitis?
The Non-invasive methods diagnostic of rinosinusitis are classic radiography, sinus echography, computed tomography and magnetic resonance imaging (RMN). Nasal endoscopy and paranasal sinuses and sinus puncture (maxillary sinus) are invasive methods diagnostic of rinosinusitis, but and therapeutic methods by draining of sinus secretions. Spectrum of pathogens include viruses addition, aerobic bacteria (Haemofilus influenzae, Streptococcus pneumonia, Moraxella catarrhalis, streptococci, staphylococci), rarely anaerobic bacteria and fungi. Unlike acute sinusitis where are frequently isolates only one bacterium, in chronic sinusitis predominates polymicrobial associations.
Methods of treatment
The antibiotic treatment has an optimal duration of 10-14 days. Using the estimation of Marchant type, antibiotics were ordered in a scale of effectiveness, predictive estimated to in adults patients with acute bacterial rhino-sinusitis.
Also, are indicated additional treatments:
Nasal irrigation with saline solution (normal saline or hypertonic solution);
Humidification of inspired air (hot vapor inhalations);
Topical decongestants (optimal duration of treatment is 5-7 days to reduce the risk of dependence);
Antihistamines and topical corticoids.
Surgery. Establishing indications for surgical treatment has been hampered by the lack of uniform criteria for defining of chronic rhino-sinusitis, the lack of an unanimously accepted staging system of rhino-sinusitis.
Absolute indications for surgical treatment:
Chronic rhino-sinusitis with mucocel / mucopiocel;
Invasive fungal rhino-sinusitis.
Relative indications for surgical treatment:
The chronic rhino-sinusitis to adult which necessitated various medical treatments for the symtomatic control of sinus suffering and who have not obtained the marked improvement;
Recurrence episodes of acute rhino-sinusitis. The failure of medical treatment represents the indication for surgical treatment. Can occur the complications its. Some of these are the affecting of other sinuses (poly / pansinusitis), conjunctival complications, orbital-ocular complications, otitis tongue / suppurated, endocranial complications (meningoencephalitis, superior longitudinal sinus thrombophlebitis, thrombophlebitis cavernous sinus).