Acute sinusitis (急性鼻竇炎)

Aetiology:
Stasis and acute infection of sinus secretions may result from any pathological or anatomical abnormality obstructing free sinus drainage. The common cold is the most frequent cause. Acute maxillary sinusitis can also result from apical infection of an upper tooth root. The causative organism is usually Pneumococcus, Streptococcus viridans or Haemophilus influenzae.

Complications:
Left untreated, acute sinusitis can rarely lead to orbital cellulitis, cavernous sinus thrombosis or intracranial abscess formation. Chronic sinusitis is a far more common sequela.


Maxillary sinusitis

Clinical features:
Most common type overall. Facial or dental pain may occur, as may referred otalgia. Nasal obstruction and purulent rhinorrhea are also frequent. Local tenderness may be the only physical sign. An occipitomental X-ray usually shows a fluid level on one or both sides, but this investigation is increasingly being replaced by CT scanning.

Management:
Treat with antibiotics and topical nasal decongestants. An antral washout through the inferior meatus may be necessary if resolution with antibiotics does not occur, but this form of treatments is decreasing in popularity with the advent of endoscopic management of sinusitis.


Ethmoiditis

Incidence:
Most common in young children who have poorly developed maxillary sinuses.

Clinical features:
Usually presents as persistent headache and orbital cellulitis following a cold. Untreated, an orbital abscess and blindness may occur.

Management:
Treatment requires hospital admission. Antibiotics are given and the maxillary sinuses washed out if also infected. Rarely, an external ethmoidectomy may be necessary. A CT scan should be performed if there is any question of an orbital abscess.


Frontal sinusitis
Potentially the most serious acute sinusitis. The long course of the frontonasal duct makes it particularly prone to obstruction by mucosal oedema.

Clinical features:
Presents as frontal headache after an upper respiratory tract infection. Local tenderness is common, but may be the only sign. A sinus CT scan usually shows a fluid level or complete opacification in one or both sinuses.

Management:
Treatment is with antibiotics, but sinus trephine and insertion of drainage tubes is undertaken if rapid resolution does not occur.


Sphenoiditis

Clinical features:
This rare form of sinusitis may present as a deep central, reto-orbital or vertex headache. Diagnosis is confirmed by a lateral X-ray or CT scan. Sinus drainage may be necessary if there is not a quick response to antibiotic therapy.