: Symptomatic inflammation of the paranasal sinuses as a result of impaired drainage and retained secretions. Could be Acute lasting for 4 weeks, or Chronic lasting for more than 12 weeks. Involved sinuses could be maxillary, ethmoid and sphenoid.
- Infection is usually viral, could be bacterial strep pneumoniae, H. flu or M. Cararrhalis, in acute sinusitis, and staph or pseudomonas or gram negatives in chronic sinusitis, Rarely fungal with Aspergillus.
- Causal and associated factors are – deviated nasal septum, tonsillar or adenoidal adenopathy, nasal polyps, turbinate hypertrophy, asthma and other allergies, dental infections and procedures.
- Usually preceding features of upper respiratory infection. Symptoms include nasal block, coloured nasal discharge, unilateral facial pain and heaviness aggravated by bending, cough and sneezing. retro-orbital pain, tenderness over sinuses, cough especially on lying down.
- Examination reveals purulent rhinorrhoea, nasal congestion and obstruction or polyp, mild hemifacial swelling, mentation changes.
- Diagnosis by clinical features, plain X-ray (mucosal thickening beyond 8 mms, sinus opacification, fluid and air levels) but may miss ethmoidal or sphenoidal sinusitis. Transnasal endoscopic or sublabial aspiration of pus is the gold standard for diagnosis but required only in resistant cases for culture of aspirate for giving specific antibiotics. CT scan will reveal those missed by X-rays.