Chronic Sinusitis

Clinical features:
HEENT examination elicits tenderness and edema. Mild mucopurulent rhinorrhoea, nasal obstruction and facial pain/frontal headache, with or without upper toothache.
Diagnosis:
2 major criteria or 1 major and 2 minor criteria
Major criteria

• Purulent nasal discharge
• Purulent pharyngeal drainage
• Cough

Minor criteria

• Periorbital edema
• Headache
• Facial pain
• Tooth pain
• Earache
• Sore throat
• Foul breath
• Increased wheeze
• Fever

Treatment:

Medical

• Corticosteroids
• Administering nasal steroids with head inverted may be more effective in cases of sinusitis refractory to traditionally applied nasal steroids.
• Antibiotics may provide short-term relief but not long-term benefit.
• Saline nasal irrigation
• Intranasal hypertonic saline washes

Surgery

• Surgical drainage if medical treatment fails
• Functional Endoscopic Sinus Surgery (FESS)
• Adenoidectomy is an alternative

Complications:

• Suppurative CNS complications
• Pott's puffy tumor
• Frontal bone osteomyelitis and subperiosteal abscess.