What is Chronic Sinusitis? How it treats?

Chronic sinusitis is characterized by symptoms of sinus inflammation lasting _12 weeks. This illness is most commonly associated with either bacteria or fungi, and clinical cure in most cases is very difficult. Many patients have undergone treatment with repeated courses of antibacterial agents and multiple sinus surgeries,

increasing their risk of colonization with antibiotic-resistant pathogens and of surgical complications. Patients often suffer significant morbidity, sometimes over many years.

In chronic bacterial sinusitis, infection is thought to be due to the impairment of mucociliary clearance from repeated infections rather than to persistent bacterial infection. However, the pathogenesis of this condition is poorly understood. Although certain conditions (e.g., cystic fibrosis) can predispose patients to chronic bacterial sinusitis, most patients with this infection do not have obvious underlying conditions that result in the obstruction of sinus drainage, the impairment of ciliary action, or immune dysfunction. Patients experience constant nasal congestion and sinus pressure, with intermittent periods of greater severity, which may persist for years. CT can be helpful in defining the extent of disease and the response to therapy. The management team should include an otolaryngologist to conduct endoscopic examinations and obtain tissue samples for histologic examination and culture.

Chronic fungal sinusitis is a disease of immunocompetent hosts and is usually noninvasive, although slowly progressive invasive disease is sometimes seen. Noninvasive disease, which is typically associated with hyaline molds such as Aspergillus species and dematiaceous molds such as Curvularia or Bipolaris species, can present as a number of different scenarios. In mild, indolent disease, which usually occurs in the setting of repeated failures of antibacterial therapy, only nonspecific mucosal changes may be seen on sinus CT. Endoscopic surgery is usually curative in these patients, with no need for antifungal therapy. Another form of disease presents with longstanding, often unilateral symptoms and opacification of a single sinus on imaging studies as a result of a mycetoma (fungus ball) within the sinus. Treatment for this condition is also surgical, although systemic antifungal therapy may be warranted in the rare case where bony erosion occurs. A third form of disease, known as allergic fungal sinusitis, is seen in patients with a history of nasal polyposis and asthma, who often have had multiple sinus surgeries. Patients with this condition produce a thick, eosinophilic mucus with the consistency of peanut butter that contains sparse fungal hyphae on histologic examination. Patients often present with pansinusitis.

TREATMENT. Treatment of chronic bacterial sinusitis can be challenging and consists primarily of repeated culture-guided courses of antibiotics, sometimes for 3 to 4 weeks at a time; administration of intranasal glucocorticoids; and mechanical irrigation of the sinus with sterile saline solution. When this management approach fails, sinus surgery may be indicated and sometimes provides significant, albeit short-term, alleviation. Treatment of chronic fungal sinusitis consists of surgical removal of impacted mucus. Recurrence, unfortunately, is common.

Source: Harrison_s_Principles_of_Internal_Medicine_16th_Edition