Acute Sinusitis Infectious Diseases | Lecturio

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Another important subject among upper respiratory tract infections is that of sinusitis and we can define acute sinusitis as an inflammation of the mucosa of the paranasal sinuses of less than four weeks duration the main problem in sinusitis is obstruction of the ostia of the paranasal sinuses and of course that can be caused by malfunction of the ciliary

Apparatus that lines all the sinuses in the mucosa the other thing in evaluating a person with sinusitis or possible bacterial sinusitis is the character of the sinus secretions if they are too thick normally they can block the ostia so we need to discuss the systemic factors that cause blockage of the ostia of the sinuses and these include most commonly viral

Upper respiratory tract infection a common cold for instance or allergy these are the two most common reasons then patients can be born with a problem very mucoid secretion secretions like cystic fibrosis and the mucus of the sinuses and the entire respiratory tract is supposed to be of a certain viscosity so that the cilia within it can beat this the cilia beat

Within this mucus lining and if the if it’s too viscid they will not beat normally or if people for example are smoking they will not beat normally there are a variety of immune disorders which affect ciliary action and then there’s this rather curious entity called ciliary dyskinesia the most important manifestation of which is cartage inner syndrome cartagena

Syndrome is the constellation of sinusitis situs inversus and bronchiectasis these patients have all three of those findings and if particularly in somebody with cartagena syndrome the heart is on the right side of the chest not the left wouldn’t it be embarrassing to not recognize that so if somebody has ciliary dyskinesia make sure you pick out the right side for

The heart exam and then as i mentioned tobacco smoke and it’s it’s interesting you may know several people who smoke and are always complaining of having sinus problems then of course there can be some local insults to the face that cause obstruction of the asti of the sinuses and they can result in bacterial sinusitis like facial trauma for example prizefighters

People who do a lot of swimming and diving either for recreation or professionally can have sinus problems all of you who have done any swimming recognize the changes in pressure when you go underwater sinusitis can be a very severe and career-ending problem for high-altitude aviation maneuvers for example if a pilot develops some problem with the sinuses that

Pilot probably shouldn’t fly if he’s flying one of these fighter jets because particularly on descent the sinus pressures can change so dramatically they can have the sudden onset of very severe facial pain which could result in aircraft accident so high-altitude aviation maneuvers are very important in the military then there are people who chronically take

Congestus or antihistamines and actually they can become rather dependent on those such that their ostia seemed to be always blocked and then if a patient has to come in the hospital for surgery or for admission to the icu they may have to be intubated and put on a ventilator that can certainly block the ostia of the sinuses if they are nasally intubated there

Can be mechanical obstruction of the asti of the sinuses as some people are born with co anal atresia one of the important exams of a newborn is to make sure that the external na rays are completely paitent some people have deviated nasal septum this is a pretty common problem most most people don’t have enough deviation of their nasal septum to obstruct the

Sinus ostia but this is something that has to be examined for nasal polyps occur little kids can get foreign bodies like little plastic automobiles and things like that in their nose and then some large bowl i may form in the ethmoid sinuses that can block the ostia there so we’ve been talking about blockage of the sinus ostia well what are the consequences of

That happening well if the sinus gets blocked then you get initially an increase in sinus pressure and of course fluid is going to build up behind the blockage now eventually the oxygen is going to be absorbed out of the block sinus and eventually there’ll be negative pressure in the sinus now the other thing is that bacterial nasal and nasal pharyngeal bacteria

Can enter the sinus during sniffing some people have a chronic habit of sniffing kind of a tick and then a lot of people when they have for example a common cold will blow their nose very hard some of them sound like a foghorn when they blow their nose well they may actually get sinusitis from doing that so if you have a common cold and if you go to advising your

Patients you should tell them to blow their nose gently never blow their nose very hard so the bottom line is that fluid becomes static inside of a block sinus and if there are bugs there then the bugs can as we say set up light housekeeping in the sinus and if the ciliary apparatus doesn’t work properly that can also complicate problems a typical viral infection

Can actually eliminate some of the cilia they’ve come back but during a viral infection sometimes the cilia are destroyed and as i mentioned if the mucus layer is abnormal the ciliary action is abnormal it’s you don’t think of this often but your your sinuses are not supposed to be dry they’re supposed to be mucus every day all day in your sinuses and that keeps

The cilia moving as they are supposed to move and they normally beat toward the posterior pharynx and the secretions are normally swallowed patients who smoke cigarettes have a change in the viscosity of that mucus and i think you can imagine how that may mess up the motility of the cilia so no wonder they have sinus congestion and no wonder they have frequent

Episodes of sinusitis the microbiology of sinusitis actually reflects the upper respiratory tract flora so you shouldn’t be surprised that streptococcus pneumoniae is the most common cause of bacterial sinusitis followed close behind by hamas influenza anaerobes are not a real common cause of sinusitis unless the patient has chronic blockage of the ostia that’s

When anaerobes can survive there streptococcus species don’t cause acute sinusitis very often moraxella catarrhalis has a low incidence in adults but a much higher incidence in children and miscellaneous pathogens and staph aureus account for the rest so acute sinusitis is common but it’s most commonly caused by viruses and i just want to point out that children

And those adults who have small children know this very well children get the common cold five to seven times each year and so do their parents now adults who don’t have small children will get two to three colds a year you probably can document on your own that on your own experience i want to point out however how uncommon complicating bacterial sinusitis

Is only six to thirteen percent of kids get bacterial sinusitis even though they get five to seven common colds a year so that’s pretty unusual and adults get bacterial sinusitis from zero point two to two point five percent of the time so most of the time when an adult comes into the office complaining of nasal congestion and having purulent nasal secretions

They still have the common cold they don’t have bacterial sinusitis and it’s over diagnosed and it certainly is over treated with antibiotics so in a viral upper respiratory tract infection it starts out as everybody knows clear and watery and it then becomes thick and mucoid and even in viral sinusitis viral common colds it becomes greenish and yellowish all

That means is that neutrophils have come into the secretions and made the color yellow or green low-grade fever is not common in adults but it is fairly common in children and the common cold and we should all advise our patients of this the common cold lasts normally five to ten days so the patients are likely to come in to the doctor in the second week of the

Illness saying i’m not well i’ve got bacterial sinusitis doc i want some antibiotics but they still have the residual of a common cold most of them not bacterial sinusitis we start thinking about bacterial sinusitis if they’ve had more than ten days of nasal discharge if they have low-grade fever if they have malodorous breath which reflects the possibility of

Anaerobic contamination and we certainly worry about it if they have periorbital edema because that usually means a bacterial sinusitis viruses don’t do that we also think about it if their symptoms were getting better from their common cold but now they’re starting to have increased discharge and congestion so they were starting to ease off and then they turn

Around and start going the other way or if they develop new fever or if they start developing a cough in the daytime so one of the things that is most important to an evaluating physician is how long the respiratory symptoms have been there that’s the most useful factor for diagnosing bacterial infection symptoms are signs lasting more than 10 days without

Clinical improvement of any kind that’s when we think about bacterial sinusitis certainly if they have purulent nasal discharge and high fever for 3 to 4 days because high fever isn’t common in viral pharyngitis or let’s say they have new fever headache or increased discharge after five to six days of a typical viral syndrome and by the way the headache is

Generally located anteriorly where the sinuses are and particularly aggravated by leaning forward those are indications of a possible bacterial sinusitis so if a patient has what we call double sickening we would begin to think about bacterial super infection what about imaging in acute sinusitis this is overused as well on an uncomplicated bacterial sinusitis

You don’t need to image the sinuses if you were to image somebody with a common cold and it’s done far too frequently you would find sinus thickening you might even find air fluid levels in the sinuses of somebody who has nothing more than the common cold the imaging generally can’t confirm a diagnosis of bacterial sinusitis just one aside is that if somebody

Had fungal sinusitis you may show invasion of the bones that would be a serious problem but generally imaging is not indicated in acute sinusitis you

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Acute Sinusitis – Infectious Diseases | Lecturio By Lecturio Medical