SINUSITIS
Sinusitis is a common condition defined as inflammation of the paranasal sinuses.
Sinusitis can be acute or chronic. Causes of sinus inflammation include viruses, bacteria, fungi,
allergies, and an autoimmune reaction.
Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or
by swelling of the lining of your sinuses. Also called chronic rhinosinusitis, the condition can affect
both adults and children.
TYPES
• Acute. Symptoms last less than 4 weeks and get better with the right care.
•
• Subacute. This type of infection does not get better with treatment at first.
Symptoms last 4 to 8 weeks
• Chronic. Chronic infection happens with repeated or poorly treated acute
infections. These symptoms last 8 weeks or longer.
• Recurrent. If you have 3 or more episodes of acute sinusitis in a year, it’s called
recurrent.
SIGNS AND SYMPTOMS
Common signs and symptoms of chronic sinusitis include:
• Nasal inflammation
• Thick, discolored discharge from the nose (runny nose)
• Drainage down the back of the throat (postnasal drainage)
• Blocked or stuffy (congested) nose causing difficulty breathing through your nose
• Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
• Reduced sense of smell and taste
Other symptoms include
• Ear pain
• Headache
• Aching in your upper jaw and teeth
• Cough or throat clearing
• Sore throat
• Bad breath
• Fatigue
AETIOLOGY
Common causes of chronic sinusitis include:
• Nasal polyps. These tissue growths can block the nasal passages or sinuses.
• Deviated nasal septum. A crooked septum — the wall between the nostrils — may
restrict or block sinus passages, making the symptoms of sinusitis worse.
• Other medical conditions. The complications of conditions such as cystic fibrosis,
HIV and other immune system-related diseases can lead to nasal blockage.
• Respiratory tract infections. Infections in your respiratory tract — most commonly
colds — can inflame and thicken your sinus membranes and block mucus drainage.
These infections can be caused by viruses or bacteria.
• Allergies such as hay fever. Inflammation that occurs with allergies can block your
sinuses.
RISK FACTORS
• A deviated nasal septum
• Nasal polyps
• Asthma
• Aspirin sensitivity
• A dental infection
• A fungal infection
• Tumors
• An immune system disorder such as HIV/AIDS or cystic fibrosis
• Hay fever or another allergic condition
• Regular exposure to pollutants such as cigarette smoking
PATHOPHYSIOLOGY
The most common cause of acute sinusitis is an upper respiratory tract infection
(URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that
usually resolves without treatment in less than 14 days. If symptoms worsen after 3 to 5
days or persist for longer than 10 days and are more severe than normally experienced
with a viral infection, a secondary bacterial infection is diagnosed. The inflammation can
predispose to the development of acute sinusitis by causing sinus ostial blockage.
Although inflammation in any of the sinuses can lead to blockade of the sinus ostia, the
most commonly involved sinuses in both acute and chronic sinusitis are the maxillary and
the anterior ethmoid sinuses.7 The anterior ethmoid, frontal, and maxillary sinuses drain
into the middle meatus, creating an anatomic area known as the ostiomeatal complex .
The nasal mucosa responds to the virus by producing mucus and recruiting
mediators of inflammation, such as white blood cells, to the lining of the nose, which cause
congestion and swelling of the nasal passages. The resultant sinus cavity hypoxia and
mucus retention cause the cilia—which move mucus and debris from the nose—to
function less efficiently, creating an environment for bacterial growth.
If the acute sinusitis does not resolve, chronic sinusitis can develop from mucus
retention, hypoxia, and blockade of the ostia. This promotes mucosal hyperplasia,
continued recruitment of inflammatory infiltrates, and the potential development of nasal
polyps. However, other factors can predispose to sinusitis.
DIAGNOSIS
• Imaging tests. Images taken using CT or MRI can show details of sinuses and nasal
area. These might pinpoint a deep inflammation or physical blockage, such as
polyps, tumors or fungi, that's difficult to detect using an endoscope.
• PHYSICAL Examination- A thin, flexible tube with a fiber-optic light inserted
through nose allows to see the inside of sinuses. This can help your to see a
deviated nasal septum, polyps or tumors.
• An allergy test. If allergies might be triggering chronic sinusitis, an allergy skin
test can be done. A skin test is safe and quick and can help detect what allergen is
responsible for nasal flare-ups.
• Samples from nasal and sinus discharge (cultures). Cultures are generally
unnecessary for diagnosing chronic sinusitis. However, when the conditions fail to
respond to treatment or is worsening, then taking swab inside your nose to collect
samples that might help determine the cause.
DIFFERENTIAL DIAGNOSIS OF SINUSITIS
[Link] HEADACHE
[Link] HEADACHE
[Link]
[Link] ABSCESS
[Link] EMPYEMA
MANAGEMENT
1. REST
2. USE OF WARM COMPRESS
3. DRINK FLUIDS
4. MOISTEN SINUS CAVITY
5. RINSE SINUS CAVITY
COMPLICATIONS OF SINUSITIS
[Link]
[Link]
[Link]
[Link] OF SURROUNDING STRUCTURES
CASE PRESENTATION
Name of patient- V.S Chandra kiran
Age – 25
Sex- male
Address- Gudivada
Occupation- civil contractor
Op regd no- 6712
Date of visit- 24/05/2022
PRESENTING COMPLAINTS
• Nose blockage and coryza for 4 years
• One sided face pains
• Headache during< head bath, cold weather, >applying balm
• Headache for 5 years
• Location- temple to nape of neck< head bath , sun exposure
History of presenting complaints
Started before 4 years after loosing her mother due to tile falling on her. After this
incident he got shocked.
Got affected with covid after that incident and sinusitis after getting recovered from
covid. He Used allopathic medicines and balms and got temporary relief.
Past History
H/O Renal Calculi
H/O Covid, took treatment and recovered ,Vaccination 3 doses completed
Family history
• Father- Apparently Healthy
• Mother- Died due to accident
• Siblings- Elder brother apparently HealthyAppearance- Average Built
Personal History
• Accommodation- own house
• Economic status – Middle class
• Diet & food habits- regular
• Addictions – NA
• Vaccination –As per schedule ,No known reactions
Physical Generals
• Appearance- Average Built
• Appetite – good
• Thirst - increased
• Desire – ice creams , spicy food
• Aversion – N.S
• Stool- soft, regular
• Urine-clear
• Sleep – refreshed
• Dreams- of suffering of something
• Perspiration – profuse on head
• Thermals – ambithermic
Mental Generals
• H/O grief +++ ( after sudden death of mother)
• Fright & shock due to that incident
• Anxious that something may happen
• Gets angry if someone does anything wrong
• Forgetful
Life Space Investigation
• Born through normal delivery he is the second child in the family. No h/o delayed
milestones.
• He is a contractor by occupation. His mother died off a tile falling over her. After
that incident he was shocked and depressed. He got affected with covid and after
that continuously suffering with sinusitis. Anxiety . Gets angry if someone does
wrong.
Physical Examination
• GENERAL EXAMINATION
• Consciousness- conscious
• Appearance- moderate
• Height – 5’6”
• Weight- 61 kg
• Anaemia – na
• Jaundice- na
• Cyanosis-na
• Oedema – na
Vital Signs
• Temprature- 98.7 f
• Pulse- 74 bpm
• Respiration rate- 70/min
• Blood pressure- 110/70 mm of hg
PROVISIONAL DIAGNOSIS
Chronic Sinusitis
CASE PROCESSING
• Analysis of symptoms
• Evaluation of symptoms
• Hahnemann classification of disease
• Miasmatic analysis
• Selection of medicine
ANALYSIS OF SYMPTOMS
MENTAL GENERALS
• Grief +++
• Depressed after death of mother
• Anxious,
• Angry with wrong doings of others
PHYSICAL GENERALS
• Desire- ice creams, spicy foods
• Thirst- increased , at long intervals
• Dreams – of suffering
• Perspiration- profuse , on forehead
• Thermals – ambithermic
PARTICULARS
• Nose blockage alternate sides < head bath , cold weather
• One sided face pain, lt .>rt
• Headache , temple to nape of neck <head bath, sun exposure
EVALUATION OF SYMPTOMS
• Continuous grief
• Depression after death of mother
• Angry from mistakes of others
• Desire – ice cream
• Desire- spicy food
• Thirst – increased , at long intervals
• Dreams – of suffering
• Perspiration- profuse over head
• Nose blockage alternate sides <head bath, cold weather
• One sided face pain , Lt > rt
• Headache , temple to nape of neck < head bath, sun heat
Hahnemann classification of disease
• Chronic Dynamic Disease with fully developed symptoms
Miasmatic Analysis
Symptoms of psoric nature
Anxious
Angry with mistakes
Fright and shock after accident
Desire – spicy things
Headache <sunheat
Nose blockage
Thirst increased
Symptoms of sycotic nature
Continuous grief
Forgetful
Depression after death of mother
Desire – ice cream
Nose blockage < cold weather
H/o renal stone
Symptoms of syphilitic nature
Desire – ice cream
Perspiration more on head at night
Pre Dominant Miasm
Psora predominant
Selection of Medicine
• Non reportorial approach
• Miasmatic approach
[as indications are clear]
Selection Of Repertory
• Kent Repertory
• Mental symptoms are predominant
• Generals are predominant
Conversion of Symptoms into Rubric
Mind-Grief, ailments after
Mind- sadness , mental Depression
Mind- Restlessness, Anxious
Stomach-Desire, Fruit
Stomach- Desire ice cream
Perspiration -profuse eating while
Nose- obstruction one sided
Face- Pain (prospalgia)
Head- Pain extending temples to nape of neck
Head- pain sunheat aggravation
Repertorial Result
Nat mur- 16/7
Ignatia- 15/8
Puls - 14/6
Calc. - 13/6
Nux-v - 12/6
Sulph- 12/6
Assessment Of Susceptability
Moderate to high
Selection of Remedy potency and dose
Dated 24/05/22
Ignatia 200/ 1 dose
SL for 15 days and then follow up
FOLLOW UP 1
Date 14/06/22
Pt little better
After 1 week of medication pain reoccurred
Sleeplessness for ¾ days
Cough for 1 week< night
Prescription-
Ignatia 1M/ 1 dose , follow up after 15 days
FOLLOW UP 2
Date 30/06/22
Better after medication
Headache mild and nose blockage is still there
Pain and stiffness of neck for 1 week (after sudden weather change)
Prescription -
Rhus tox 200/ 1 dose
SL for 7 days and then report
Follow Up 3
Date- 7/7/22
Pt better
Neck pain not there
Headache better but nose blockage is still there
One sided face pain
Prescription –
Ignatia 1m/ 1 dose
SL for 15 days
FOLLOW UP 4
Date 16/08/2022
Pt better
All symptoms better
Cough for 1 week
Prescription – SL for 15 days
FOLLOW UP 5
Date 15/09/22
Old symptoms reappeared
Headache nose blockage for 10/15 days
One sided face pain
Prescription-
Nat mur 200/ 1 dose
SL for 15 days
FOLLOW UP 6
Date 14/12/2022
Pt was better after medication
Headache better
Pain and stiffness of neck for 7 days after getting wet in rain
Prescription - Rhus tox 200/ 1 dose
SL for 7 days
FOLLOW UP 7
Date 21/02/23
Pt is better
No neck pain
Headache pain from temple to face
Sinusitis
Prescription- Nat Mur 200/ 1 dose.