The issue of chronic sinusitis is an extremely important topic from a population perspective, as it is one of the most frequently diagnosed conditions associated with upper airway obstruction. Aetiologically, it is an incompletely clear problem as well as the multifactoriality involved when talking about sinusitis makes diagnosis and appropriate treatment a difficult task for the ENT physician.
Table of contents:
The problem of sin usitis is a widespread disease phenomenon. In 2005, scientific standards were defined for the first time, supported by facts and evidence provided by medicine at the sinusitis and nasal polyps congress. The experts, appointed by the European Academy of Allergy and Clinical Immunology, proposed solutions to guide the diagnosis and treatment of sinusitis, based on the experience and medical facts encountered by clinicians worldwide when dealing with this condition. The recommendations then referred to were adopted, accepted and updated by the European Society of Rhinology in 2007 [1].
Sinusitis - what is it?
To speak of sinusitis, there must be inflammation within the nasal mucosa that spreads to the surface of at least one of the sinuses. This is because the two membranes (the nasal mucous membrane and the mucous membrane lining the paranasal sinuses) form a common whole. According to the accepted definition, the inflammatory process of the mucous membrane must be characterised by at least two of the several symptoms that may appear. These include impairment or loss of smell, a feeling of fullness in the face, a sense of congestion, nasal obstruction, nasal discharge or discharge running down the back wall of the throat and pain. An additional diagnostic element is endoscopic examination during a routine ENT visit, which may reveal nasal polyps, mucopurulent discharge, as well as mucosal thickening as seen on nasal imaging (CT) [1].
Pathological processes
Chronic sinusitis itself has a very complex aetiology and pathogenesis. Many different types of factors contribute to its development, course and nature. The key to talking about sinus problems is to determine the level of nasal patency, which can often be related to craniofacial trauma, but also to recurrent, chronic mucosal inflammation problems in the upper respiratory tract. It is also worth noting other factors that may contribute to patency disorders, such as environmental pollutants, car exhaust, cigarette smoke or the element of side effects during treatment with certain medications. Sometimes the problem of sinus patency and inflammation is related to medical errors, which may occur during dental treatment, when a complication may be the opening of the sinus and the consequent development of inflammation. The very morphology, structure and arrangement of the bones that a person has can influence the increased risk of sinus inflammation occurring [2].
What is the cause?
There is much speculation in the specialist literature about the aetiology of the development of sinusitis , but the current state of medical knowledge does not allow a clear answer to the question of what causes the development of inflammation. A number of factors are assumed to co-occur and overlap, with viruses believed to play a significant role in the development of such processes. They may contribute to the development of inflammation itself, as well as being a factor in its maintenance and continuous activation [2].
Sinusitis, photo: panthermedia
Both the greatest severity of symptoms and the most frequent incidence of disease are observed in autumn and spring, which further supports the thesis of a viral influence on the development of sinusitis. However, a number of factors predisposing to the onset and development of this condition can also be identified. These include all types of weaknesses and immune deficiencies, abnormal anatomy and bone morphology, gastrointestinal reflux and also allergies [3].
Severe or mild?
During the physician's interview with the patient, it is crucial to ask about the patient's feelings of discomfort. This is because the question about the severity of the symptoms helps determine whether the sinusitis the patient is suffering from is severe or mild. Specialists place the answers on a scale that distinguishes between mild, moderate and severe degrees of severity. A VAS scale is used to derive a score, on which the patient marks the value he or she feels is appropriate [1].
Chronic sinusitis
In order to speak of a chronic course of the condition, it must have lasted a sufficient amount of time, namely a duration of the condition of less than 12 weeks indicates an acute course if, in addition, all symptoms disappear during this period.
If the patient has symptoms for more than 12 weeks and the symptoms are more or less constant, this is called the chronic course of the condition. In addition, it should be borne in mind that the inflammation and symptoms themselves are not uniform and that there may be periods of exacerbation and intensification during the course of the disease.
The duration and persistence of symptoms for more than 12 weeks is one of the essential eligibility criteria. In addition, in order to exclude other concomitant conditions, it is necessary to ask about allergic complaints such as sneezing, pruritus, burning sensations or tearing and watery nasal discharge [1].