Acute purulent sinusitis is an acute suppurative inflammation of the nasal sinus mucosa, which can involve the bone in severe cases. The maxillary sinus, due to its larger cavity, lower floor, and higher ostium, is prone to pus accumulation. Located below the other sinuses, it is also more susceptible to infection from other areas. Therefore, maxillary sinusitis has the highest incidence, followed by ethmoid sinusitis, then frontal sinusitis, with sphenoid sinusitis being the least common.

bubble_chart Etiology

(1) Local Disease Causes

1. Infection and Nasal Diseases: Often secondary to respiratory infections or acute rhinitis. High deviation of the nasal septum, hypertrophy of the middle turbinate, nasal polyps, nasal tumors, foreign bodies, or prolonged placement of packing can obstruct sinus drainage and lead to disease. Improper diving or jumping techniques during swimming may allow contaminated water to enter the sinuses through the nasal cavity, causing infection.
2. Trauma: The anterior group of sinuses, particularly the maxillary and frontal sinuses, are superficially located and prone to trauma, leading to fractures. Bacteria can invade the sinuses through the skin or nasal mucosa. Infections may also arise from foreign objects such as shrapnel or dust entering the sinuses.
3. Odontogenic Infections: The roots of the maxillary second premolar and first and second molars are located near the floor of the maxillary sinus. Infections in these tooth roots may perforate the sinus wall, or injuries to the sinus floor during tooth extraction can cause maxillary sinusitis, known as dentogenic maxillary sinusitis.
4. Pressure Changes: During aviation, diving, or mountain climbing, sudden changes in pressure can create negative pressure in the nasal cavity, leading to injury, known as baro-traumatic sinusitis.

Excessive fatigue, malnutrition, vitamin deficiencies, allergic constitution, endocrine disorders, as well as various chronic sexually transmitted diseases such as anemia, subcutaneous nodules, diabetes, chronic nephritis, etc., weaken the body's resistance and serve as predisposing factors for sinusitis. It may also occur secondary to acute infectious diseases like influenza.

bubble_chart Diagnosis

1. Nasal obstruction: Due to congestion and swelling of the nasal mucosa and accumulation of secretions, persistent nasal obstruction on the affected side and temporary olfactory dysfunction may occur.
2. Purulent nasal discharge: There is a significant amount of mucopurulent or purulent secretions expelled from the affected nostril. In the early stages, the discharge may contain small amounts of blood. In cases of odontogenic maxillary sinusitis, the discharge may have a foul odor.
3. Local pain and headache: Acute sinusitis often involves not only pain in the inflamed nasal area but also severe headache. This is caused by the pressure from mucosal swelling and retained secretions in the sinus cavity or the traction from negative pressure after secretion drainage, which irritates the trigeminal nerve endings. The anterior group of sinuses is close to the surface of the head, so the headache is usually localized to the forehead or the affected side. The posterior group of sinuses is located deep within the head, so the headache tends to occur at the top of the head, the temples, or the back of the head.

bubble_chart Treatment Measures

The treatment principles are to control infection; improve nasal ventilation and drainage; eradicate the {|###|}disease cause{|###|} and prevent progression to chronicity.

1. Systemic treatment: Use sufficient antibiotics to control infection. Since most cases are caused by cocci, penicillin is the first-line drug. If {|###|}headache{|###|} or local pain is severe, sedatives or analgesics may be appropriately administered. The general approach is the same as for acute rhinitis.
2. Chinese medicine: Focus on dispersing wind and clearing heat, as well as {|###|}aroma unblocking nose{|###|}, supplemented by {|###|}removing toxin{|###|} and resolving stasis. Commonly used formulas include Cocklebur Fruit Powder (Cocklebur Fruit, Magnolia, Dahurian Angelica, Mentha) with modifications.
3. Improving sinus drainage: Commonly use 1% {|###|}Ephedra{|###|} solution, furacilin {|###|}Ephedra{|###|} solution, or chloramphenicol {|###|}Ephedra{|###|} solution for nasal drops. For acute frontal sinusitis or ethmoid sinusitis, the head should be tilted backward during nasal drops. For acute maxillary sinusitis, the head should be tilted sideways to reduce mucosal swelling, improve sinus ventilation and drainage, and alleviate {|###|}headache{|###|}.
4. Physical therapy: Local hot compresses, infrared irradiation, or ultrashort wave therapy may be applied.
5. Maxillary sinus puncture and irrigation: For acute maxillary sinusitis, this procedure should be performed after systemic symptoms subside and local acute inflammation is largely controlled. After irrigation, antibacterial {|###|}solution{|###|} can be injected, once or twice weekly until recovery.
6. Sinus displacement therapy: Suitable for various sinusitis cases where acute inflammation is largely controlled but significant purulent discharge and nasal obstruction persist, to facilitate sinus drainage.
7. For odontogenic maxillary sinusitis, dental treatment should be administered concurrently.

bubble_chart Differentiation

1. Local redness, swelling, and tenderness: In acute sinusitis of the anterior group, due to their proximity to the surface of the skull, the skin and soft tissues of the affected area may exhibit redness and swelling. Since the inflammation involves the periosteum, there is tenderness at the corresponding sinus cavity. Acute sinusitis of the posterior group, being deeper in location, shows no surface redness, swelling, or tenderness.
2. Nasal examination: The nasal mucosa is congested and swollen, particularly noticeable in the middle turbinate, middle meatus, and olfactory groove. In anterior group sinusitis, pus accumulation can be observed in the middle meatus, while in posterior group sinusitis, pus is seen in the olfactory groove.
3. Postural drainage: If sinusitis is suspected but no pus is found in the nasal passages, a postural drainage test may be performed to aid in diagnosis.
4. X-ray sinus imaging: X-ray images in the naso-chin and naso-frontal views assist in diagnosis. In acute sinusitis, they may reveal swelling of the sinus mucosa, turbidity in the sinus cavity, reduced translucency, and sometimes a fluid level.