NOSE – Sinusitis

What is chronic maxillary sinusitis?

The maxillary sinuses on the face are the most commonly affected sinuses. Chronic maxillary sinusitis is usually a result of improperly treated recurrent acute sinusitis.

An incidence rate of chronic maxillary sinusitis?

●  Age: Usually occurs after 16 years of age

●   Sex: Both sexes are equally affected

What are the causes of chronic maxillary sinusitis?

●  Mechanical obstruction of the ostium of the Maxillary sinus results in improper drainage of the sinuses

●  Deviated nasal septum

●  Hypertrophied turbinates

●  Adenoid hypertrophy

●  Tumors of nose and maxilla

●  Foreign bodies, rhinolith

●  Allergic rhinitis: The mucosa becomes oedematous and blocks the ostium.

●  Mucociliary clearance abnormality of the sinuses

●  Immune deficiency

●  Chronic tonsillitis and infected upper molars and premolars

●  Hormonal imbalance

What is the pathology of ethmoidal polyps?

These polyps are multiple, bilateral and have a grape like an appearance. They have a strong allergic co-relation.

What are the symptoms of ethmoidal polyps?

●   Nasal obstruction: This is usually bilateral.

●   Anosmia(Loss of sensation of smell)

●   Watery nasal discharge

●   A headache also called “Vacuum Headache”

●   Watering of the eyes-Epiphora due to blockage of nasolacrimal duct

●   Sneezing is common as these polyps are allergic in origin.

What are the clinical signs of ethmoidal polyps?

●   Hyponasal voice (Rhinolalia Clausa) is present due to bilateral nasal obstruction.

●   Broadening of the nasal bridge.

What investigations are required to confirm the diagnosis of ethmoidal polyps?

●   X-ray paranasal sinuses: They help in detecting the extent of the disease in the sinuses.

●   CT Scan of paranasal Sinuses: This is the investigation of choice. A CT Scan reveals the extent of the disease, the condition of lamina papyracea and also the posterior ethmoidal air cells and the cribriform plate.

What is the treatment for ethmoidal polyps?

Medical Treatment:

●   Antihistaminics, low dose steroids, local steroid sprays, help to regress the ethmoidal polyps to a certain extent. However, the above treatment rarely eliminates well-formed polyps and is often combined with surgery.

Surgical Treatment:

●   Functional Endoscopic Sinus Surgery (FESS): Ethmoidectomy and polypectomy using FESS and microdebrider have considerably reduced the incidence of recurrence.

●   Ethmoidectomy: It can be done, external or transantral. However, it is not commonly done.

●   Polypectomy using nasal snare was used. However it is not commonly done these days due to higher chances of recurrence, and residual disease left behind.