Sinusitis Nursing Theoritical Background

Definition of Sinusitis

Sinusitis is like a common disease in our life, it is usually like influenza. Influenza is one of the most easy recognized symptom of sinusitis. Other symptoms that may appear are fever, pain in the face-especially around the cheeks and nose, headache, and fatigue.

Sinus is a cavity in face area, so sinusitis is an inflammation of the sinus cavities. These cavities are as a place to process the incoming air through the nose before it is processed and distributed by the lungs throughout the body. Overall, there are four pairs of sinus cavities that is connected with the nose:

1. On the forehead there are two pairs of cavities, the frontal sinuses.
2. Two pairs of cavities ethmoidal located between the eyes and just behind the nose.
3. Two pairs of sinuses sfenoidalis located behind the ethmoid sinuses.
4. Two pairs of maxillary sinuses located between the cheekbone, right beside the nose.

Sinus Cavities Location

Inside the sinus cavities there are hairs called cilia. Its function is to produce the mucus in the nose. This mucus will clean respiratory tract from foreign things and microorganisms that inhaled with the air. When the sinus is swelling and inflammation, mucus can not flow normally and it will be trapped in the sinus cavities. That's why you feel like a stuffy nose.

Overall, there are two major types of sinusitis, which is based on period of disease process and based on the type of inflammation. First is based on period of disease process, sinusitis is divided into three period of disease processes:

1. acute sinusitis (less than 30 days or 1 month).
2. Sub-acute sinusitis (about 1-3 months).
3. Chronic sinusitis (more than 3 months).

And the second type of sinusitis is based on the type of infection or inflammation, it can be divided into two types, it called infectious and non-infectious sinusitis.

Etiology

Actually, sinusitis is not a primary disease, it is not stand alone. So, sinusitis will occur because of other diseases. One of the most common diseases that trigger sinusitis is common cold or influenza. While we got influenza or flu, flu virus can also attack the lining of the sinus cavities. When this happens, the body will react by producing more mucus. Mucus trapped in the sinus cavity is like an optimum situation for bacteria and germs breeding. As a result, the body will react for those infection and there is an infection and inflammation in sinus cavities.

Sinusitis can be triggered by teeth problem such as like caries. Normally, the teeth are most often the culprit sinusitis are upper molars. In some cases, the roots of molars are connected to the sinus cavity. When there is an infection in the tooth, bacteria can easily move into the sinus cavity through the root of the tooth. As a result, there is an infection and inflammation of the sinuses. Another thing that also can trigger an allergic reaction sinusitis, polyps, trauma to the face, asthma, GERD (gastro esophageal reflux disease).

In detail the sinusitis etiology are:

Acute Sinusitis

The causes of acute sinusitis can caused by viruses, bacteria, or fungi. According to Gluckman, the most common germs that cause acute sinusitis are Streptococcus pneumonia and Hemophilic influenza, the cause of microorganism were found in 70% of sinusitis cases and it is like a large number of microorganism that attack sinus cavity.

Other causes are caused by other diseases such as like acute rhinitis; pharyngeal infections, adenoiditis, acute tonsillitis. Then the teeth problem such as infection in molar tooth, especially M1, M2, M3, and premolars P1, P2. Swimming and diving can be a cause of sinusitis because the contaminated water can be inhaled unconsciously. Trauma that may leave a wound in sinus cavity.

Then the mechanical obstruction lead to sinus infection such as septal deviation, foreign things that come into the nose, tumors, or polyps. Also allergic reaction such as rhinitis, chronic rhinitis, environmental pollution.

Chronic Sinusitis

The etiology of chronic sinusitis are chemical pollution, allergy and immunologic deficiency that make defective cilia, and the result is changes in the nasal mucosa. These changes in nasal mucosa can lead to infections in many microorganism. If there is Konka edema, it will disturb drainage of secretions and make ineffective cilia or tiny hair inside the nasal cavity to bring out the microorganism. If the treatment of acute sinusitis is not show the best recovery, there will be a chronic infection of sinusitis.

Sign and Symptoms of Sinusitis

Early symptoms that may be caused by infection are runny nose with yellow or green nasal mucosa accompanied by orofacial pain in cheeks area, forehead, eye and the pain may spread to jaw and teeth. Sinusitis usually occurs after part of upper respiratory tract infection such as a common cold or influenza. Then sinus inflammation or sinusitis can be classified into 2 groups:

Acute Sinusitis

This type of sinusitis is the most common type in children. The sign and symptoms are like symptoms in flu such as like cough, nasal congestion, discharge of mucus that is not accompanied by fever and mucus color is green to yellow. If the sinusitis occurs in children, most of these symptoms will be appear about ten days and the children's conditions will be worse in day seven.

Chronic Sinusitis

Symptoms of chronic sinusitis will be similar to acute sinusitis, the different between them is just period of the disease, the chronic sinusitis sign and symptoms are longer then acute sinusitis. Chronic sinusitis sign and symptoms is still be there almost three months, and it is compounded by the pain on around the head. In addition to this type of sinusitis will be thick layer in long period of disease and it will make the tissue development and it will block the nose ways called polyps.

If we are talking about the main complaint of patients, it will be vary. But all patient will feel pain in the sinus accompanied by headache. In acute sinusitis, the patient will have an extreme pain and the pain is permanent. It is different with chronic sinusitis, the patient will not have a pain or it can be intermittent pain. Pain that is felt will be worse in 3-4 hours after wake up in the morning, because of the accumulation of exudation in the sinuses cavities. Other symptoms are like fever, sore throat, postnasal drips, and the runny nose.

Diagnosis Test

Diagnosis test for sinusitis is transillumination test. it uses a flashlight that lights affixed above the maxillary sinus with the closed mouth, then observe a bright light in sinus cavities. The normal sinus will appear as a bright light in sinus cavities because normal sinus only filled with air. If dark are found in sinus cavities during translumination, it indicates the presence of purulent secretions and sinus congestion. Examination with X-rays of the sinuses and nasal endoscopy can also be done, but this is rarely done unless the patient has a chronic and recurrent disease.

Treatment

Acute sinusitis

Acute sinusitis treatment goal is to control the infection, restore the condition of the nasal mucosa, and relieve pain. The antibiotic usually prescribed for acute sinusitis because the main problem in sinusitis is bacteria infection, the antibiotics are amoxicillin and ampicillin. An alternative treatment for patients who have allergic reaction to penicillin are trimethoprim / sulfamethoxazole (double strength) (Bactrim DS, DS Spetra). Oral or topical decongestants may be given to help the nose congestion. Warmed or irrigated saline can be effective treatment to open the obstruction, the warm saline can allow drainage of purulent mucosa. Common oral decongestant that is usually prescribed are Drixoral and Dimetapp. Topical decongestants commonly prescribed is Afrin and Otrivin. Topical decongestants should be administrated with the position of the patient's head like looking up, it is useful to increase the maximum drainage. If the patients still have symptoms after 7-10 days, then the sinus needs to be irrigated.

Chronic Sinusitis

Medical management for chronic sinusitis is as same as acute sinusitis treatment. Surgery is indicated in chronic sinusitis to repair the sinus structural deformity. Surgical excision may include polyps, septal deviation repairment, and incision and drainage of the sinus Some patients with chronic sinusitis can be cured by moving to the area with a dry climate.

Computer tomography test is indicated for the evaluation of chronic sinusitis that does not improve during the treatment, sinusitis complications, preoperative evaluation, and if there is suspicion of malignancy or tumor. Magnetic Resonance Imaging (MRI) is better than computed tomography in resolution and easy to differentiate sinusitis due to mold, neoplasms, and intra cranial expansion, but the resolution of MRI is not reflected good bone and the MRI test is so expensive.