Acute or chronic inflammatory disease of the nasal accessory sinuses
with or without suppuration is more common, I believe, and is
responsible for more complications and chronic affections of the nose
and throat than is generally known.
=Etiology.=—The cause in most cases lies in unsuccessfully treated
acute infections involving the nose and throat. Abnormalities of the
nasal respiratory passages such as deflected septum, enlarged or
cellular turbinates, adhesions resulting from cautery or careless
surgery, causing deficient drainage, constitute the local causes.
Underlying some of these direct causes, lesions of the cervical region
which impair the nutrition to and drainage from the head are to be
considered.
=Symptoms and Diagnosis.=—Acute or chronic headaches and neuralgic
pains of the head are common symptoms. Acute sinuitis of the frontal
sinuses is accompanied by marked and persistent frontal headache and
pain in the eyes. In infections of the maxillary sinus there is usually
pain over the affected part, but there is often referred pain to other
parts of the head. Sphenoidal sinuitis usually causes general headache
with no definite location.
By direct examination of the nasal cavities a purulent or mucopurulent
discharge may be seen and the source determined. In many cases,
however, the pus may be retained or insufficient in amount to detect by
direct examination.
Transillumination in a dark room by means of a good transilluminator
will usually show a darkened area over the affected part. The average
battery equipments commonly sold for this purpose are of little value.
The X-ray plate when properly done, is more dependable than the
transilluminator.
In some cases, all of these methods fail to locate the affected sinus
and the cause can be found only by opening into the sinuses, aspirating
with a catheter and making microscopic examination of the aspirated
material. The microscope is indispensable for this work. Every
suspicious discharge should be stained until pus is found and except
in well defined cases, this is the only practical method of positive
diagnosis.
=Treatment.=—Local treatment of the nasal cavities by retracting the
turbinates and irrigation will be successful in many cases, but unless
there is a large normal opening the pus will not drain sufficiently
and probe treatment is required. In acute cases in which the pain is
marked, osteopathic treatment of the cervical region, deep relaxation
of the submaxillary structures and the application of heat over the
affected part, together with the local nasal treatment should be given,
but if this does not relieve the pain within twenty-four hours, the
sinus should be opened and thoroughly drained. If efficient drainage is
not established early the symptoms will usually increase until the pain
is almost unbearable and serious complications may result.
In practically every case of acute sinuitis, I believe it is best to
make a good, free opening into the affected sinus first and secure
complete drainage by catheter aspiration. If this is properly done
every case will recover much more quickly and without complications or
danger of chronic infection.