DEFINITION
The sinusitis is a frequent illness that owes to the infection of one or more of the bosoms paranasal (cavities in the bones of the skull).
CAUSES
The primary cause that he leads to the sinusitis is the obstruction of the orifices of the bosoms. With this obstruction, the blood circulation and the ventilation of the cavity sinus are minor, which leads to a descent of the PO2 that favors the bacterial growth. The infection can be sharp, intermittent or chronic. The most habitual causers are the bacteria, although etiologies viral and rarely mycotic also they produce sinusitis.
The Streptococcus pneumonia, Homophiles influenzal and Moraxella catarrhalis are the bacteria met more frequent the farming of mucus (pus). The viral causes understand rhinovirus, cold virus type A and virus parainfluenza. In the patients infections of sinusitis can take place fungal, as the produced one by Aspergillum fumigates.
The sharp sinusitis is usually preceded of a viral infection of the airways top or associated with nasal polyps that have blocked the effective drainage. Other factors associated with the sinusitis are rhinitis allergic, rhinitis vasomotor, syndromes of shortcoming of antibodies, ciliary malfunction, strange bodies and dental infections, etc…

SYMPTOMS
The most frequent symptoms of sharp sinusitis are a migraine, mucus secretion and fever. Other symptoms are the epistaxis (bled of nose), general discomfort, cough, hyposmia (absence in smell), pain to the masticating and aphonia. In the children with chronic sinusitis, the cough is the most habitual complaint; the fever is less frequent.
The patients with chronic sinusitis present in general secretion postnasal purulent, nasal congestion and migraines. Other symptoms are a cough, halitosis and rhibirrhea chronicle. The intense facial pain is an infrequent symptom in the patients with chronic sinusitis. In any cases the patients have no symptoms.
DIAGNOSIS
The case history and the physical exploration are essential and they can identify the purulent sinusitis in 80 % of the cases. In the clinical examination, the mucous nasal red, dropsical one can be visualized, with nasal purulent secretion associated with sensibility of the bosom to the pressure. On the contrary, the physical exploration in the chronic sinusitis can be normal or to reveal nasal polyps or nasal purulent secretion. The X-ray skills of image, like the radiography of bosoms and the scanner computerized (TAC), must be reserved for diagnostic difficult problems and for the insensitive sinusitis’s to the antibiotics.
The scanner computerized is useful to visualize the content and the bony anatomy of the bosoms, especially if sinusitis is suspected sphenoidal and ethmoidal or neoplasia. In the patients with sinusitis , it is necessary to consider allergic and not allergic factors. In addition to the cutaneous tests of allergy, there are useful the quantitative determinations of immunoglobulin, the test of chlorine in perspiration and the studies of ciliary motility
COMPLICATIONS
From the introduction of the antibiotics, the serious complications of the sinusitis paranasal are infrequent. These complications can consist in osteomyelitis of the frontal bosom, empyema extradural subdural and thrombosis of cavernous bosom. The sinusitis ethmoidal sharp is more frequent in the children than in the adults and it can cause tumefaction it would orbit and periorbital unilaterally and cellulitis.
TREATMENT
The medical current therapeutics go to treat the infection and to achieving the drainage of the bosoms.
The antibiotics of election in the sinusitis, both sharp and chronic, are the ampicillin and the amoxicillin; nevertheless, the producing bacteria of B-lactamasa are a constant problem. You MUST KILL The Bacteria
They are valid alternatives the amoxicillin-clavulámico, the cefaclor, the trimetoprim-sulfametoxazol, the cefuroxima, the eritromicina-sulfizoxazol and clindamicina.
The duration of the treatment of the sharp sinusitis must be of at least ten fourteen days and that of the chronic sinusitis of three four weeks.
The treatments of support to reduce the edema tissue and to relieve the obstruction of the orifices sinuses understand the administration of oral decongestants and corticosteroids hackneyed.
In the patients with rhinitis allergic, the combination of decongestants and antihistamínes can help to reduce the secretions. In some cases, nasal topics are used decongestant for two three days followed by nasal hackneyed steroids, since the hackneyed decongestant in the long term can cause rhinitis . In some patients with nasal significant obstruction and nasal polyps, there is needed a brief cycle of prednisone of seven ten days.
There needs surgical consultation in the cases of sharp complicated sinusitis, insensitive sinusitis to the medical energetic therapeutics and chronic sinusitis recurrent (more than four episodes a year). The surgical interventions must go followed by medical treatment, which understands the use of corticosteroids topics to minimize the reappearance of nasal polyps. The surgical interventions understand the wash sinuses, the creation of an orifice expanded to provide effective drainage and ventilation, and the resection of the sick textile.