CHRONIC SINUSITIS

• Sinusitis refers to inflammation of the mucosa of one or more paranasal sinuses where the muco-ciliary clearance mechanism is affected leading to blockage of the sinus ostium
• It rarely occurs without concurrent inflammation of the nasal mucosa (rhinitis) and is therefore commonly referred to as rhinosinusitis
• Chronic sinusitis is an inflammatory process that involves the paranasal sinuses and persists for 12 weeks or longer. The primary symptoms are purulent rhinorrhoea and facial pain (particularly when leaning forward)
• Chronic sinusitis is almost always accompanied by concurrent nasal airway inflammation and is often preceded by rhinitis symptoms; thus, the term chronic rhino sinusitis (CRS) has evolved to more accurately describe this condition
• Current consensus classifies CRS into CRS with nasal polyps and CRS without nasal polyps

Pathogenesis

Spread of infection may occur through

• Direct spread through the wall of the sinus
• Venous spread
• Lymphatic spread
• Spread through perineural spaces of olfactory nerve

Predisposing Factors

• Mechanical obstruction
• Anatomical and pathological obstruction in the region of the osteomeatal complex leads to impaired muco-ciliary clearance, inadequate drainage of sinuses, stagnation of secretions and persistent secondary infection
• Focal infection
• Muco-ciliary clearance Abnormality
• Allergy
• Immunodeficiency - Body defence mechanism is suppressed in diseases like AIDS, and patients on long term steroidal use
• Autonomic imbalance
• Hormonal changes
• Granulomatous conditions like Sarcoidosis, Amyloidosis, Tuberculosis, Leprosy, Syphilis usually present with rhinitis and secondary sinusitis
• Iatrogenic
• Idiopathic

• Purulent nasal discharge -common
• Local pain and head ache- often mild
• Nasal stuffiness
• Anosmia or hyposmia
• Loss of taste
• Nasal obstruction
• Hawking sensation due to post nasal drip

Complications

Local

• Mucocele/ Mucopyocele
• Mucous retention cyst
• Osteomyelitis - Frontal bone (more common), Maxilla

Orbital

• Pre-septal inflammatory oedema of lids
• Subperiosteal abscess
• Orbital cellulitis
• Superior orbital fissure syndrome
• Orbital apex syndrome

Intra cranial

• Meningitis
• Extradural abscess
• Subdural abscess
• Brain abscess
• Cavernous sinus thrombosis

Descending infections

• ASOM
• CSOM
• SOM
• Pharyngitis
• Tonsillitis
• Laryngitis
• Bronchitis
• Bronchiectasis

Focal infection

• X-ray PNS –shows mucosal thickening and haziness of the affected sinus
• CT scan of PNS –detect associated anatomical and pathological abnormality
• Diagnostic nasal endoscopy – Mucosal erythema, Oedema
• Aspiration and irrigation

Medical

• Conservative- including antibiotics, decongestants, antihistamines, and sinus irrigations
• Culture and sensitivity helps in proper selection of antibiotics

Surgical

• Endoscopic surgery provide good drainage and ventilations

Ayurvedic Treatment

Pathyas : Advice to avoid cold items

Internal Medicines

• Dashamoola katutraya kashaya
• Vyaghradi kashaya
• Amrutarishta
• Chavikasava
• Vyoshadi vataka
• Lakshmi vilasa rasa
• Vettumaran gutika
• Indukantha gritha
• Rasayanaprayoga – Chyavana prasa, Dasamoola harithaki to prevent recurrence

Procedures

• Lepa - Rasnajambeeram (Pain relieving)
• Kabala - Triphala kashaya+ Trikatu choorna
• Nasya - Surasa swarasam +Saidava+Honey , Nimbasava + saindhava
• Choorna Nasya - Trikatu choornam
• Shirodhara - Surasa taila (If sinus tenderness is absent)
• Jaloukavacharana - forehead
• Oil for head – Balahatadi, Nirgundyadi, Surasa taila