Tuesday, April 7, 2009

Investigations and Diagnosis

Investigations and Diagnosis


An X-ray of the para nasal sinuses is often the first test done. Haziness or opacities in the region of the infected sinus is often seen. Sometimes a CT Scan may be required for confirmation. The discharge from the sinus is sent for culture and the organism isolated, and appropriate antibiotics may be given. Sometimes transillumination of the involved sinus may be helpful. The affected sinus produces a dark shadow as opposed to a normal sinus, which produces a light shadow. Tests to check for the presence of infection and ESR may be done to gather supportive evidence. Fungal scrapings and smears may be taken from the discharge and fungal cultures have to be done if a fungal aetiology is suspected.





Treatment and Prognosis


The treatment may be either medical or surgical. The initial treatment involves administration of appropriate antibiotics along with an analgesic and an anti-histaminic. Steam inhalation and nasal spray could also provide relief and may be used to relieve the congestion. Avoiding nasal irritants and allergens may help. Irrigation and drainage of the affected sinus is sometimes done.
Surgical treatment involves puncturing the sinus and making a window in it to facilitate easy drainage. Other procedures include the Caldwell-Luc procedure for chronic maxillary sinusitis and ethmoidectomy for ethmoid or sphenoid sinusitis. The prognosis is often quite good and depends upon the sinuses involved and the duration of the infection. Most patients who have acute sinusitis of a short duration generally recover with appropriate early therapy. However chronic sinusitis can be quite a problem and even after drainage patients may be symptomatic. Some patients may require radical surgical techniques for cure.

Prevention


While there are no vaccines to prevent sinusitis and it is impossible to predict who will develop it except in a small number of patients who have an anatomic defect in their nose, early diagnosis and treatment is the only practical solution.

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