Chronic Sinusitis
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Questions and Answers

What is the primary cause of chronic sinusitis?

  • Low-grade inflammation in the antral mucosa
  • Polypoidal type of inflammation
  • Inadequately treated acute or subacute disease (correct)
  • Prolonged use of nasal drops

    • What is the radiographic picture of chronic sinusitis?

  • Sinus lining thickening only
  • Sinus opacity with a horizontal fluid level and sinus polyps (correct)
  • No radiographic signs
  • Sinus opacity without a horizontal fluid level

    • What is the primary treatment for chronic sinusitis?

  • Oxygenation of the sinuses through opening of the ostia (correct)
  • Rest and fluid only
  • Decongestants and nasal drops
  • Antibiotics and analgesics

    • What is the usual treatment duration for antibiotics in acute sinusitis?

    <p>5-7 days</p> Signup and view all the answers

    What is the complication of chronic sinusitis that can lead to formation of multiple or single mucosal polyps?

    <p>Polypoidal type of inflammation</p> Signup and view all the answers

    What is the common symptom of chronic sinusitis?

    <p>Dull pain and intermittent headache</p> Signup and view all the answers

    What is the local treatment for chronic sinusitis?

    <p>Daily irrigation of the sinus with warm saline or steam inhalation</p> Signup and view all the answers

    What is the difference between chronic and acute sinusitis?

    <p>Duration of the disease</p> Signup and view all the answers

    What is the result of loss of permanent teeth and alveolar bone on the sinus?

    <p>Pneumatization of the sinus</p> Signup and view all the answers

    What is the primary function of the maxillary sinus?

    <p>Lightening the weight of the skull</p> Signup and view all the answers

    What is the best view for sinus examination in radiographic examination?

    <p>Waters view</p> Signup and view all the answers

    What is the duration of disease classified as acute sinusitis?

    <p>Less than 1 month</p> Signup and view all the answers

    What is the cause of sinusitis in a patient with an oro-antral fistula?

    <p>Oro-antral fistula</p> Signup and view all the answers

    What is the term used to describe sinusitis lasting 1 to 3 months?

    <p>Subacute sinusitis</p> Signup and view all the answers

    What is the purpose of transillumination in clinical examination of sinusitis?

    <p>To diagnose sinusitis</p> Signup and view all the answers

    What is the term used to describe inflammation of the mucosal lining of the sinus?

    <p>Acute sinusitis</p> Signup and view all the answers

    What is a potential complication of maxillary sinusitis?

    <p>Osteomyelitis</p> Signup and view all the answers

    What is the primary goal of decongestants in treating sinusitis?

    <p>To decrease congestion of the nasal mucosa and relief nasal obstruction</p> Signup and view all the answers

    What is the name of the surgical procedure mentioned in the text for treating sinusitis?

    <p>Functional Endoscope Assisted Sinus Surgery (FEASS)</p> Signup and view all the answers

    What is the consequence of an Oroantral Communication (OAC)?

    <p>Invasion of bacteria into the sinus, causing sinusitis</p> Signup and view all the answers

    What is the difference between a fistula and a communication?

    <p>The type of lining differs between a fistula and a communication</p> Signup and view all the answers

    What is a possible cause of an Oroantral Communication (OAC)?

    <p>Extraction of maxillary teeth</p> Signup and view all the answers

    What is a sign of a recent Oroantral Communication (OAC)?

    <p>Unilateral epistaxis</p> Signup and view all the answers

    What is the primary goal of antibiotics in treating sinusitis?

    <p>To control and overcome infection</p> Signup and view all the answers

    Study Notes

    Sinusitis

    • Defined as disease lasting more than three months
    • Usually due to inadequately treated acute or subacute disease
    • Considered irreversible by medical therapy alone
    • Oxygenation of the sinuses through opening of the ostia is the primary treatment

    Signs and Symptoms of Sinusitis

    • Headache
    • Pain and tenderness
    • Nasal obstruction
    • Nasal discharge
    • Heavy feeling when bending
    • Nasal congestion
    • Fever and malaise

    Radiographic Picture of Sinusitis

    • Sinus opacity
    • Horizontal fluid level (usually unilateral sinus opacity if of dental cause)

    Treatment of Sinusitis

    • Rest and fluid intake
    • Antibiotics for 5-7 days
    • Analgesics and antihistamines
    • Decongestant and nasal drops to shrink mucosa lining and drainage
    • Local treatment: daily irrigation of sinus with warm saline or steam inhalation (especially if oro-antral fistula present)

    Chronic Sinusitis

    • Result of prolonged low-grade inflammation in antral mucosa following acute phase or recurrence of acute sinusitis
    • Antral mucosa is thickened with edema and sometimes accompanied by creation of polyp
    • Signs and symptoms:
      • Dull pain and intermittent headache
      • Posterior nasal discharge
      • Nasal congestion
      • Repeated attacks of acute mucopurulent rhinitis
      • Toothache during chewing
    • Radiographic picture:
      • Sinus opacity with horizontal fluid level
      • Sinus lining thickening
      • Sinus polyps are also present

    Function of Sinuses

    • Lighten the weight of the skull
    • Warm the air
    • Resonance of voice
    • Act as a shock absorber
    • Regulation of intranasal pressure

    Clinical Examination of Sinusitis

    • Tapping on the lateral wall of the sinus extraorally and palpation intraorally
    • Transillumination (old method)
    • Sinoscope (recent method)

    Radiographic Examination of Sinusitis

    • Waters view: best view for sinus examination
    • Panoramic view: provides a good overview of both maxillary sinuses
    • Intraoral views (Occlusal & Periapical views): demonstrates the relation of root apices to the floor of the sinus
    • Submento-vertex view: demonstrates the posterior wall of the maxillary sinus
    • Occipito-frontal view: shows all the paranasal sinuses, useful to exclude pansinusitis
    • Lateral sinus projection: confirms the presence of fluid or cyst or foreign body in the sinus
    • Computerized tomography (CT): detection of neoplasms and bony wall erosions within the sinus

    Maxillary Sinusitis

    • Acute sinusitis: suppurative or non-suppurative inflammation of the mucosal lining of the sinus
    • Causes:
      • Infection from dental abscess
      • Infection from cystic lesion of related teeth
      • Dental material pushed into sinus
      • Tooth pushed into sinus
      • Oro-antral fistula
      • Facial fracture involving sinus

    Pathophysiology of Sinusitis

    • Acute sinusitis: disease lasting less than one month
    • Subacute sinusitis: disease lasting 1 to 3 months

    Treatment of Acute Sinusitis

    • Analgesics: to relieve pain
    • Antibiotics: to control and overcome infection
    • Decongestants: to decrease congestion of the nasal mucosa and relieve nasal obstruction
    • Surgery: surgical removal of polyps and thickened lining if present, through Functional Endoscope Assisted Sinus Surgery (FEASS)

    Complications of Maxillary Sinusitis

    • Orbital abscess and orbital cellulitis
    • Intracranial abscesses
    • Meningitis
    • Cavernous sinus thrombosis
    • Spread of infection to neighboring sinuses, structures, and organs
    • Osteomyelitis
    • Gastrointestinal disturbances

    Oroantral Communication (OAC)

    • Abnormal connection between the oral cavity and the maxillary sinus
    • Etiology:
      • Extraction or instrumentation around maxillary teeth
      • Facial trauma
      • Surgical procedure
      • Malignant neoplasms
      • Other causes (osteomyelitis and syphilitic gamma of the palate)

    Why OAC is a Problem

    • Allows the flow of food and fluids from the mouth into the nose, leading to invasion of bacteria into the sinus and causing sinusitis

    Signs and Symptoms of OAC

    • Recent OAC:
      • Escape of fluids from the mouth into the nose
      • Unilateral epistaxis
      • Inability to blow out the cheeks due to escape of air from the mouth to the nose
      • Bubbles of blood from the socket

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    Description

    This quiz covers the definition, symptoms, and treatment of chronic sinusitis, a disease that lasts more than three months and is often caused by inadequately treated acute or subacute disease.

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