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Dentaljuce Shorts: 500 words, 10 MCQs, on general medicine and surgery.

Sinusitis

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses, leading to symptoms such as thick nasal mucus, a plugged nose, and facial pain.

It is commonly seen in individuals with underlying conditions such as allergies or structural nasal problems, and those with lower immunity. Most cases are caused by viral infections, but bacterial and fungal infections can also be culprits.

A CT scan showing sinusitis of the ethmoid sinus
A CT scan showing sinusitis of the ethmoid sinus

Signs and Symptoms

The primary symptoms of sinusitis include headache, facial pain, or pressure, particularly over the affected sinuses, which can worsen when bending over or lying down. Acute sinusitis may present with a thick, green nasal discharge possibly containing pus or blood. Localised headaches, toothaches, and postnasal drip are also common. Chronic sinusitis can lead to symptoms like nasal congestion, facial pain, night-time coughing, and an increased severity of asthma symptoms. Additionally, anosmia (loss of smell) is frequently observed in chronic cases.

Illustration depicting sinusitis, note the fluid in the sinuses
Illustration depicting sinusitis, note the fluid in the sinuses

Diagnosis

Sinusitis is classified into several categories based on duration and recurrence: acute (up to four weeks), subacute (4-12 weeks), chronic (over 12 weeks), and recurrent acute (four or more episodes per year). Diagnosis is typically based on symptoms, but imaging studies like CT scans or MRIs may be used for chronic cases or when complications are suspected.

CT of chronic sinusitis
CT of chronic sinusitis
CT scan of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone
CT scan of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone
MRI image showing sinusitis. Oedema and mucosal thickening appears in both maxillary sinuses.
MRI image showing sinusitis. Oedema and mucosal thickening appears in both maxillary sinuses
Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis
Maxillary sinusitis caused by a dental infection associated with periorbital cellulitis
Frontal sinusitis
Frontal sinusitis
X-ray of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side.
X-ray of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side.

Treatment

Treatment for sinusitis varies depending on the cause and severity. For most cases, rest and hydration are recommended. Nasal irrigation can help relieve congestion, while decongestant nasal sprays may offer temporary relief. Antibiotics are generally reserved for bacterial sinusitis that does not improve within 10 days or worsens. Amoxicillin or amoxicillin/clavulanate is typically the first line of antibiotic treatment, with the latter being slightly more effective.

Benign chronic mixed inflammation of an inflammatory sinonasal polyp
Benign chronic mixed inflammation of an inflammatory sinonasal polyp
Acute inflammation characterised by neutrophils
Acute inflammation characterised by neutrophils
Extranodal NK/T cell lymphoma, nasal type. It may be incidentally discovered in people undergoing surgery for sinusitis.
Extranodal NK/T cell lymphoma, nasal type. It may be incidentally discovered in people undergoing surgery for sinusitis.

Nasal corticosteroids may be useful for reducing inflammation, particularly in chronic sinusitis. Surgery, such as Functional Endoscopic Sinus Surgery (FESS) or balloon sinuplasty, may be considered for chronic or recurrent cases that do not respond to medical treatments.

A CT scan showing sinusitis of the ethmoid sinus
A CT scan showing sinusitis of the ethmoid sinus

Complications

Complications of sinusitis, although rare, can be severe. These include orbital cellulitis, brain abscesses, and meningitis. Early diagnosis and treatment are very important for preventing such outcomes. Chronic sinusitis may also lead to chronic mouth breathing, increasing the risk of gingivitis.

Epidemiology

Sinusitis is prevalent, affecting between 10% and 30% of people each year in the developed world. Chronic sinusitis affects about 12.5% of people, leading to significant healthcare costs. The condition is commonly mismanaged with unnecessary antibiotic treatments for viral infections, contributing to antibiotic resistance.


Self-assessment MCQs (single best answer)

What is the primary cause of most sinusitis cases?



Which of the following is a common symptom of chronic sinusitis?



How long does acute sinusitis typically last?



Which imaging study is commonly used for diagnosing chronic sinusitis?



What is the first line of antibiotic treatment for bacterial sinusitis?



Which complication is NOT typically associated with sinusitis?



What percentage of people in the developed world are affected by sinusitis each year?



Which treatment is often reserved for chronic or recurrent sinusitis that does not respond to medical treatment?



Which symptom is frequently observed in chronic sinusitis cases?



Which of the following conditions is commonly mismanaged with unnecessary antibiotic treatments?



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