Tuesday, April 3, 2012

Acute frontal sinusitis (AFS)

Acute frontal sinusitis (AFS)

AFS is acute sinusitis with symptoms concentrated in the forehead area. The symptoms are limited to the frontal bone, temple and brow region. Acute frontal sinusitis may cause frontal headache due to a change in pressure within the frontal sinus. Blockage of the frontonasal opening and infundibulum creates negative pressure or vacuum, causing the headache. During this headache-sinus, patient may feel tenderness in the supraorbital ridge, orbital floor and / or frontal sinus region. The tenderness is particularly experienced in the areas in which frontal sinus is the thinnest. Acute frontal sinusitis headache starts over the sinus and spreads to the rear of the eyes or the vertex.




Sometimes, although rhinorrhea, nasal congestion and other symptoms are absent, acute headache-sinus occurs. AFS is common in young and adolescent male population. Acute frontal sinusitis accompanies acute ethmoid and maxillary sinusitis. However, information about bacteriology of AFS is very limited, as access to the frontal sinus is difficult. As a result, collecting and studying the sinus cultures are difficult.
The patients having frontal headaches should consult an otolaryngologist, who will identify whether sinus or nasal pathology is causing the headache. Generally, severe frontal headache for short duration accompanies acute frontal sinusitis. This headache is related to nasal symptoms. Chronic frontal sinusitis patients also complain about a headache, which is represented by constant dull pressure. However, this headache usually does not have nasal symptoms.
Acute frontal sinusitis can be of two types: complicated and uncomplicated. The uncomplicated AFS cures itself in response to improvement in immunity. The viral infection of the upper respiratory tract may lead to uncomplicated AFS. If symptoms persist for about ten days, it may be a bacterial infection.  Moraxella catarrhalis, Streptococcus penumoniae and Hemophilus influenza trigger uncomplicated AFS. The uncomplicated AFS requires an antibiotic therapy for 10-14 days to control infection, eliminate obstructions and restore the sinus.
The complicated AFS may have dangerous consequences. Severe sinusitis symptoms persisting over a prolonged period represent complicated AFS. The complicated AFS requires CT scan with IV Contrast and an aggressive medication strategy.  The treatment comprises a serial neurological check up, intravenous hydration and intravenous antibiotic therapy. Surgery may also be required.  Only some patients may experience severe headache-sinus.  If patients also have intracranial abscesses, surgical drainage of the frontal sinus is necessary. The drainage can be done using external ethmoidectomy, endoscopic frontal sinusotomy and / or trephination.

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