DEFINITION

The sinusitis is a frequent illness that owes to the infection of one or more of the bosoms paranasales (cavities in the bones of the skull).

CAUSES

The primary cause that he leads to the sinusitis is the obstruction of the orifices of the bosoms. With this obstruction, the blood circulation and the ventilation of the cavity sinusal they are minor, what gives place to a descent of the PO2 that favors the bacterial growth. The infection can be sharp, intermittent or chronic. The most habitual causers are the bacteria, although etiologías viral and rarely micóticas also they produce sinusitis.

The Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the bacteria met more frecuenciaen the cultivation of exudation (pus). The viral causes understand rhinovirus, virus gripal type A and virus parainfluenza. In the patients inmunosuprimidos sinusitis infections can take place micótica, like the produced one by Aspergillus fumigatus.

The sharp sinusitis is usually of a viral infection of the airways top or associated preceded with nasal polyps that have blocked the effective drainage. Other factors associated with the sinusitis are rinitis allergic, rinitis vasomotora, syndromes of shortcoming of antibodies, ciliary malfunction, quística fibrosis, strange bodies and dental infections, etc...

SYMPTOMS

The most frequent symptoms of sharp sinusitis are a migraine, mucopurulenta secretion and fever. Other symptoms are the epistaxis (bled of nose), general discomfort, cough, hiposmia (lacking in smell), pain to the masticating and aphonia. In the children with chronic sinusitis, the cough is the most habitual complaint; the fever is less frequent.

The patients with chronic sinusitis present in general secretion posnasal purulent, nasal congestion and migraines. Other symptoms are a cough, halitosis and rinorrea chronicle. The intense facial pain is an infrequent symptom in the patients with chronic sinusitis. In any cases the patients have no symptoms.

DIAGNOSIS

The case history and the physical exploration are essential and they can identify the purulent sinusitis in 80 % of the cases. In the clinical examination, a red, dropsical nasal mucous membrane can be visualized, with purulent nasal secretion associated with sensibility of the bosom to the pressure. On the contrary, the physical exploration in the chronic sinusitis can be normal or reveal nasal polyps or purulent nasal secretion. The X-ray skills of image, like the radiography of bosoms and the scanner computarizada (TAC), must be reserved for difficult diagnostic problems and for the insensitive sinusitises to the antibiotics.

The scanner computarizada is useful to visualize the content and the bony anatomy of the bosoms, especially if sinusitis is suspected esfenoidal and etmoidal or neoplasia. In the patients with sinusitis recidivante, it is necessary to consider allergic and not allergic factors. In addition to the cutaneous allergy tests, there are useful the quantitative determinations of antibody, the test of chlorine in perspiration and the studies of ciliary motilidad.

COMPLICATIONS

From the introduction of the antibiotics, the serious complications of the sinusitis paranasal are infrequent. These complications can consist in osteomielitis of the frontal bosom, empiema extradural subdural and thrombosis of cavernous bosom. The sinusitis etmoidal sharp is more frequent in the children than in the adults and it can cause tumefaction it would orbit and periorbitaria unilaterally and cellulitis.

TREATMENT

The current medical therapeutics go to treat the infection and to achieve the drainage of the bosoms.

The election antibiotics in the sinusitis, both sharp and chronic, are the ampicilina and the amoxicilina; nevertheless, the producing bacteria of B-lactamasa are a constant problem.

Valid alternatives are the amoxicilina-clavulámico, the cefaclor, the trimetoprim-sulfametoxazol, the cefuroxima, the eritromicina-sulfizoxazol and clindamicina.

The duration of the treatment of the sharp sinusitis must be of at least ten fourteen days and that of the chronic sinusitis of three four weeks.

The support treatments to reduce the edema tisular and to relieve the obstruction of the orifices sinusales comprise the administration of oral descongestivos and corticosteroides local.

In the patients with rinitis allergic, the combination of descongestivos and antihistamines can help to reduce the secretions. In some cases, nasal topics are used descongestivos for two three days followed by local nasal steroids, since the long-term local descongestivos can cause rinitis medicamentosa. In some patients with significant nasal obstruction and nasal polyps, there is needed a brief cycle of prednisona of seven ten days.

There needs surgical consultation in the cases of complicated sharp sinusitis, insensitive sinusitis to the energetic medical therapeutics and chronic sinusitis recidivante (more than four episodes a year). The surgical interventions must go followed by medical treatment, which comprises the use of corticosteroides topics to minimize the reappearance of nasal polyps. The surgical interventions comprise the wash sinusal, the creation of an orifice expanded to provide effective drainage and ventilation, and the resection of the sick textile.

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