Definition and Classification of Sinusitis

鼻竇炎的定義及分類

Justin Hao M.D. 郝治華

沙鹿童綜合醫院耳鼻喉頭頸外科

Definition :

As the suffix " itis " indicates , sinusitis means an inflammatory change in the mucosa of a sinus. When such a pathologic change occurs , definite signs and symptoms are produced . Most of the signs can be seen on physical examination of the nose or can be demonstrated by rentgenograms or other special diagnostics procedures. Inflammatory sinus disease most commonly results from or exacerbated by areas of obstruction within the sinuses . Recent revision of an understanding of mucociliary clearance has placed a renewed emphasis on sinus anatomy , particularly in identifying natural sinus ostia. Upon review of the history of concepts regarding modern endoscopic sinus surgery , the origin of inflammatory sinus disease of the frontal or maxillary sinuses was noted as early as 1916, when J. Parsous Schaeffer noted that " the maxillary sinus is often a.cesspool for infectious material from the sinus frontalis and certain of an anterior groups of cellulae ethmoidalis ". Development of endoscopic sinus technology enabled Messerklinger , Stamm berger , and Wigand to re-examine sinus anatomy from the standpoint of mucocilliary clearance and drainage. Sinusitis , especially as it relates to allergies , is one of the most commonly overlooked and misdiagnosed and treated inappropriately. With a better understanding of the pathophysiology of sinus discase , advances in diagnostic technique, and the advent of endoscopic surgery , the evaluation and treatment of sinusitis are undergoing major evolution. Until recently , many primary care physicians discounted the importance of pediatric sinusitis. and some openly questioned whether sinusitis even existed as a distinct entity in young children . With newer surgical techniques , otolaryngologists are partly responsible the children's chronic rhinorrhea . Improved sinus imaging via computed tomography and magnetic resonance imaging has also contributed greatly to recent enhanced awareness of pediatric sinusitis .

Classification :

Sinusitis may be conveniently classified in a number of ways : acute , subacute , or chronic ; suppurative or nonsuppurative , allergic or non allergic, odontogenic , and fungal sinusitis etc . Actually , the most practical way to regard sinusitis for purposes of medical management is a continum influenced in its evolution by a number of facts . The patient may experience recurrent acute episodes sinusitis or may develop progressive and eventually irreversible mucous membrane damage leading to chronic disease . The course and character of sinusitis are influenced by various factors : exposure to bacterial pathogens.(e.g., in children , parents, teachers , and health workers ) ; repeated or chronic episodes of mucous membrane edema with hypersecretion and stasis caused by upper respiratory allergy , obstruction of the osteomeatal complex due to altered anatomy ( septal deviation , turbinate hypertrophy ) or physiology ( crusts and thick secretions ) ; and impaired function ( immune deficiency , immotile cilia syndrome, cystic fibrosis ) . Thus , in order to properly treat sinusitis , on must understand and treat all the contributory factors in each case . When considering a diagnosis of sinusitisin a child or an adult , the major problem is to distinguish , on the one hand , simple URI or allergic inflammation from , on the other hand , secondary bacterial infection of the paranasal sinuses .