A distinction is made between acute and chronic sinusitis. The only decisive factor here is the duration of the disease’s progression. Acute sinusitis is diagnosed when a purulent secretion of the nose persists for up to 12 weeks. If the symptoms persist for at least 12 weeks and beyond, it is called chronic sinusitis. By definition, it is an independent inflammatory reaction of the sinus mucosa or one that accompanies the common cold.
Acute sinusitis is caused by the passageways, called ostia, to the sinuses. This can be triggered by swelling of the excretory ducts or a mucosal disposition. The chronic course of sinusitis is more characterized by a gradually increasing obstruction of the ostiomeatal unit.
The most common pathogens are viruses, bacteria of the nasal flora or, more rarely, fungi. The following are being discussed as predisposing factors for sinusitis: allergies, analgesic intolerance, asthma, and natural constrictions.
The symptomatology of sinusitis is closely related to the localization of the affected sinus:
- If the ethmoid or maxillary sinuses are affected, a severe headache develops that radiates behind the affected eye and creates pressure and percussion tenderness in the anterior wall of the maxillary sinus.
- If the frontal sinus is affected, there is a frontal headache with an increase in symptoms when bending over.
- If the sphenoid sinus is involved, the pain is more toward the back of the head.
If all sinuses are affected, it is called pansinusitis.
The diagnosis of acute sinusitis is based on the medical history and examination alone, whereas a CT scan of the sinuses is indicative if chronic sinusitis is suspected. Ultrasound diagnostics and X-rays are of secondary importance.
The treatment procedure depends on whether the sinusitis is acute or chronic.
Treatment of sinusitis
In most cases, treatment for acute sinusitis consists of conservative therapy in the form of decongestant nasal drops, direct application of medicine via cotton swabs, administration of moist and dry heat, and additional consideration of antibiotic therapy to prevent or treat bacterial superinfection. Immediate additional surgical repair only becomes necessary in case of orbital or intracranial complications.
Treating chronic sinusitis
Treatment of chronic sinusitis additionally includes administration of topical and systemic corticosteroids. If this does not bring significant relief, surgical restructuring is recommended as part of the paranasal sinus surgery. The main objective of this intervention is the ventilation of the sinuses after expansion of the ostia. Today, this is mainly done endonasally or, in rare cases, externally, in a manner that is either endoscopically or microscopically supported. At this point, however, it must be acknowledged that recurrences may occur.