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Definition
Sinusitis is a common disease caused by infection with one or more of the sinuses (cavities in the bones of the skull).
Sinusitis

Causes
The main causes that lead to sinusitis is obstruction of the sinus openings. With this obstruction, blood circulation and ventilation of the lower sinus cavity, which causes a decrease in Po2 that support bacterial growth. Infection can be acute, intermittent or chronic. The most common cause is bacterial, fungal and viral aetiology, although rare can also cause sinusitis.

Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the bacteria most frequently plant found expenditures (pus). The virus causes including rhinovirus, influenza virus type A and parainfluenza viruses. In immunocompromised patients can cause sinusitis fungal infections, such as that produced by Aspergillus fumigatus.

Acute sinusitis is usually preceded by a viral infection upper respiratory tract or associated with nasal polyps have been blocked effective drainage. Other factors associated with allergic rhinitis, sinusitis, vasomotor rhinitis, antibody deficiency syndrome, ciliary dysfunction, cystic fibrosis, foreign bodies and dental infections, etc.. …

Symptoms
The most common symptoms of acute sinusitis is headache, mucopurulent discharge and fever. Other symptoms include Epistaxis (nosebleeds), malaise, cough, hyposmia (absence of smell), pain when chewing and hoarseness. In children with chronic sinusitis, cough is the most common complaints, fever is less common.

Patients with chronic sinusitis usually have a purulent postnasal discharge, nasal congestion and headaches. Other symptoms are cough, Rhinorrhea and chronic halitosis. The face of intense pain are common symptoms in patients with chronic sinusitis. In some cases patients have no symptoms.

Diagnosis
History and physical examination is very important and can identify purulent sinusitis in 80% of cases. On clinical examination, nasal mucosa can be red, swollen, purulent nasal secretion, associated with breast tenderness to pressure. In contrast, a physical examination may be normal chronic sinusitis or nasal polyps express or purulent nasal fluids. Radiographic imaging techniques such as sinus radiography and computed tomography (CT) should be provided for difficult diagnostic problems and sinusitis unresponsive to antibiotics.

Computed tomography is useful to view the contents and the anatomy of the sinus bone, especially if you suspect sphenoid and ethmoid sinusitis or neoplasm. In patients with recurrent sinusitis, allergic and nonallergic factors to consider. In addition to allergy skin tests are useful in quantitative determination of immunoglobulins, sweat chloride test and ciliary movement studies.

Complications
Since the introduction of antibiotics, serious complications are rare paranasal sinusitis. These complications may include osteomyelitis of the frontal sinus, extradural and subdural empyema sinus thrombosis cave. Acute Ethmoid sinusitis is more common in children than in adults and can cause swelling and unilateral orbital and periorbital cellulitis.

Treatment
Current medical therapies intended to treat the infection and achieve sinus drainage.

Choice of antibiotics for sinusitis, both acute and chronic, are ampicillin and amoxicillin, but the bacteria producing B-lactamase is a constant problem.

Are alternative-applicable clavulámico amoxicillin, cefaclor, trimethoprim-sulfamethoxazole, cefuroxime, erythromycin and clindamycin-sulfizoxazol.

Duration of treatment of acute sinusitis should be at least ten to fourteen days, and chronic sinusitis in three-four weeks.

Supportive treatment to reduce swelling and remove tissue blockage Ostia sinus decongestants administration including oral and topical corticosteroids.

In patients with allergic rhinitis, the combination of decongestants and antihistamines can help reduce the secretion. In some cases, topical nasal decongestants are used for two-three days, followed by topical nasal steroids, as a long-term topical decongestants can cause rhinitis medicamentosa. In some patients with significant nasal obstruction and nasal polyps, it requires a short course of prednisone seven-ten days.

Surgical consultation is needed in cases of complicated acute sinusitis, sinusitis not responsive to aggressive medical therapy and chronic recurrent sinusitis (more than four episodes per year). Surgical procedure must be followed by medical treatment, which involves the use of topical corticosteroids to minimize the recurrence of nasal polyps. Sinus surgical interventions, including washing, creating an enlarged hole to provide drainage and aeration are effective, and the elimination of diseased tissue.

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