Thursday, February 16, 2012

Acute maxillary sinusitis: symptoms, microbiology and treatment

Acute maxillary sinusitis: symptoms, microbiology and treatment

Generally, acute maxillary sinusitis is related to viral infections of the upper respiratory tract. However, other factors, such as dental problems may also cause acute maxillary sinusitis. The sinusitis symptoms affect day-to-day life, including school / office and leisure activities. Some of the common symptoms follow:




Headache

Painful sensation

Maxillary tooth pain

Facial pressure or pain

Swelling over the sinus

Moderate to severe nasal obstruction

Pus coming out from the middle meatus

Extremely stale and bad smelling breath

Pain may vary from moderate to severe.

Pain increases while pressing the maxilla.

Numbness in maxillary premolars and molars

Posterior and / or anterior nasal drainage (rhinorrhea)

Pain may occur in different parts such as ear, posterior teeth and cheek.

Microbiology
The acute maxillary sinusitis microbiology is well defined. The main pathogens are facultative anaerobic and aerobic bacteria. The facultative anaerobes depend on fermentation process for energy required to grow when oxygen is inadequate, and use oxygen if it is available in sufficient amount. The following bacteria have been found in the adult patients with acute maxillary sinus symptom (s):
Anaerobes

Enterobacter

Escherichia coli

Haemophilus influenze

Moraxella catarrhalis

Neisseria coli

Pesudomonas aeruginosa

Staphylococcus aureous

Streptococcus penumoniae

Streptococcus sp


There are two (2) types of strains of the facultative gram-negative coccobacillus Haemophilus influenzae: encapsulated and unencapsulated.  The unencapsulated strains cause bronchitis, otitis media, sinusitis and other infections of upper respiratory tract. Streptococcus penumoniae, a ά-hemolytic group of streptococci, are resistant to various antibiotics. The aerobic and gram-negative coccobacilli Moraxella catarrhalis are also resistant to some isolates.
These three bacteria also cause acute maxillary sinus symptom(s) in children. However, Moraxella catarrhalis-related infections are common in children than adults, since respiratory aerosols spread the infection.

Treatment
Acute maxillary sinusitis lasts for four or less weeks and sinus symptom(s) appear suddenly.  Subacute maxillary sinusitis signs persist from four (4) to twelve (12) weeks. If treated in time and completely, acute maxillary sinusitis is resolved fully. The therapy may consist of intranasal corticosteroids, nasal lavage and vasoconstrictors. The oral treatment may include antibiotics, analgesics, mucolytics and antipyretics. The acute sinusitis caused by H. influenzae, S. pneumoniae or M. catarrhalis can be treated with macrolides.

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