Diseases Of The Nose Throat And Ear

CHAPTER 14
CHRONIC SINUSITIS

Chronic sinusitis usually follows an acute sinusitis in which the infection has
failed to resolve because it was undiagnosed, untreated or insufficiently
treated. Certain cases of chronic maxillary sinusitis may arise from a dental
cause in which there has been no acute sinusitis. One or more of the paranasal
sinuses may be involved, and the condition may be unilateral or bilateral.
The maxillary sinuses are the most commonly involved, and next the ethmoidal
sinuses with polypus formation.

The latent character of the infection may cause it to be unsuspected by the
patient or the practitioner. Provided that the ostium remains even partially
patent there will be an evacuation of a small amount of mucopus without any
acute symptoms associated with blockage of the opening. Attention may only
be drawn to chronic sinus disease in the course of a search for the origin of a
complaint unrelated by the patient to his nasal sinuses. Inflammatory lesions
in the pharynx, larynx, bronchi and middle ears are obvious examples, as is
offensive breath, but gastric symptoms, rheumatic pains, neuralgias
ophthalmic disorders or general malaise may on occasion be associated with
chronic sinusitis, the treatment of which may afford relief. In such cases the
absence of any gross nasal discharge or its non-purulent character may
explain why attention is not directed to the sinuses.

SYMPTOMS. Nasal discharge is the most common symptom, the discharge
being either blown out of the nose or felt trickling into the nasopharynx and
pharynx. It is not always easy for the patient to determine the date of onset of
the condition as months or years may have elapsed since the initial infection.
Maxillary sinusitis arising from a carious tooth may have been insidious from
the first. Nasal discharge varies in its amount and character. It may be so slight
as to be hardly noticeable except with each fresh cold. The discharge may be
transparent tenacious mucus or it may show any appearance and consistence
up to creamy yellow pus, occasionally with crust formation. It may or may not
be foetid, imparting an offensive odour to the breath, this being especially
apparent with crust formation. The amount of the discharge may be increased
on stooping. Postnasal catarrh is frequently present, and may be swallowed or
spat out. This is not an invariable sign of sinusitis because nasal secretion is
propelled towards the choanae and any condition within the nose which
alters the consistence or amount of nasal secretion will lead to its becoming
noticeable to the patient.

Nasal obstruction of varying degree is found in chronic sinus infection, and
is due to the infected oedema of the nasal mucosa or to polypus formation. A
slowly developing nasal obstruction is less obvious to the patient than a rapid
occlusion from a growing polypus.

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