The maxillary sinuses on the face are the most commonly affected sinuses. Chronic maxillary sinusitis is usually a result of improperly treated recurrent acute sinusitis.
An incidence rate of chronic maxillary sinusitis?
● Age: Usually occurs after 16 years of age
● Sex: Both sexes are equally affected
What are the causes of chronic maxillary sinusitis?
● Mechanical obstruction of the ostium of the Maxillary sinus results in improper drainage of the sinuses
● Deviated nasal septum
● Hypertrophied turbinates
● Adenoid hypertrophy
● Tumors of nose and maxilla
● Foreign bodies, rhinolith
● Allergic rhinitis: The mucosa becomes oedematous and blocks the ostium.
● Mucociliary clearance abnormality of the sinuses
● Immune deficiency
● Chronic tonsillitis and infected upper molars and premolars
● Hormonal imbalance
These polyps are multiple, bilateral and have a grape like an appearance. They have a strong allergic co-relation.
What are the symptoms of ethmoidal polyps?
● Nasal obstruction: This is usually bilateral.
● Anosmia(Loss of sensation of smell)
● Watery nasal discharge
● A headache also called “Vacuum Headache”
● Watering of the eyes-Epiphora due to blockage of nasolacrimal duct
● Sneezing is common as these polyps are allergic in origin.
What are the clinical signs of ethmoidal polyps?
● Hyponasal voice (Rhinolalia Clausa) is present due to bilateral nasal obstruction.
● Broadening of the nasal bridge.
● X-ray paranasal sinuses: They help in detecting the extent of the disease in the sinuses.
● CT Scan of paranasal Sinuses: This is the investigation of choice. A CT Scan reveals the extent of the disease, the condition of lamina papyracea and also the posterior ethmoidal air cells and the cribriform plate.
What is the treatment for ethmoidal polyps?
● Antihistaminics, low dose steroids, local steroid sprays, help to regress the ethmoidal polyps to a certain extent. However, the above treatment rarely eliminates well-formed polyps and is often combined with surgery.
● Functional Endoscopic Sinus Surgery (FESS): Ethmoidectomy and polypectomy using FESS and microdebrider have considerably reduced the incidence of recurrence.
● Ethmoidectomy: It can be done, external or transantral. However, it is not commonly done.
● Polypectomy using nasal snare was used. However it is not commonly done these days due to higher chances of recurrence, and residual disease left behind.