International Journal of Medical Sciences And Clinical Research
69
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue01 2025
PAGE NO.
69-71
10.37547/ijmscr/Volume05Issue01-10
Acute purulent sinusitis: clinical course, diagnosis and
treatment methods
Sanjar Usmonov
Assistant, Department of Stomatology and Otorhinolaryngology, Fergana Medical Institute of Public Health, Fergana, Uzbekistan
Khondamir Jurayev
Assistant, Department of Stomatology and Otorhinolaryngology, Fergana Medical Institute of Public Health, Fergana, Uzbekistan
Received:
20 October 2024;
Accepted:
29 December 2024;
Published:
30 January 2025
Abstract:
This article provides a comprehensive analysis of acute purulent sinusitis, focusing on its etiology,
pathogenesis, clinical course, diagnosis, and contemporary treatment methods. The study highlights the distinct
characteristics of the disease across different age groups and emphasizes key aspects of differential diagnosis. By
exploring modern therapeutic approaches, the article aims to enhance understanding and management of acute
purulent sinusitis, offering valuable insights for clinicians to optimize patient outcomes.
Keywords:
Acute purulent sinusitis, sinusitis, diagnostics, antibacterial therapy.
Introduction:
Acute purulent sinusitis is a common
inflammatory condition of the paranasal sinuses, often
resulting from bacterial infection. It is characterized by
purulent nasal discharge, facial pain, and nasal
obstruction, significantly impacting patients' quality of
life [1]. The etiology of acute purulent sinusitis is
multifactorial,
involving
viral,
bacterial,
and
environmental triggers, while its pathogenesis is closely
linked to the obstruction of sinus ostia and impaired
mucociliary clearance [2]. Despite advances in
diagnostic and therapeutic approaches, the disease
remains a clinical challenge due to its varying
presentation across age groups and the need for
accurate differential diagnosis to distinguish it from
other sinonasal conditions [3]. This article aims to
explore the clinical course, diagnostic methods, and
modern treatment strategies for acute purulent
sinusitis, with a focus on age-specific considerations
and the importance of precise diagnosis to guide
effective management.
Etiology and Pathogenesis
Acute purulent sinusitis is primarily caused by bacterial
infection, often following a viral upper respiratory tract
infection (URTI) that leads to inflammation and
obstruction of the sinus ostia [4]. The most common
bacterial pathogens implicated in acute purulent
sinusitis
include
Streptococcus
pneumoniae,
Haemophilus influenzae, and Moraxella catarrhalis,
particularly in pediatric populations [5]. In adults,
anaerobic bacteria may also play a significant role,
especially in cases of odontogenic origin [6].
The pathogenesis of acute purulent sinusitis involves a
cascade of events triggered by the obstruction of sinus
drainage pathways. Viral URTI or allergic inflammation
causes mucosal edema, which blocks the sinus ostia
and disrupts normal mucociliary clearance [7]. This
creates an environment conducive to bacterial
colonization and proliferation. The accumulation of
purulent secretions within the sinuses further
exacerbates inflammation, leading to the characteristic
symptoms of facial pain, nasal congestion, and purulent
discharge [8].
In addition to infectious agents, predisposing factors
such as anatomical variations (e.g., deviated nasal
septum, concha bullosa), immune deficiencies, and
environmental irritants (e.g., smoking, pollution) can
contribute to the development and persistence of
acute purulent sinusitis [9]. Understanding the
interplay between these etiological factors and the
underlying pathogenic mechanisms is crucial for
effective diagnosis and targeted treatment of the
condition [10-12].
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Clinical Signs
O'tkir yiringli gaymorit quyidagi simptomlar bilan
kechadi:
•
Burun bitishi va burun orqali nafas olishning
qiyinlashishi;
•
Burundan yiringli ajralmalar kelishi;
•
Yuz sohasida, ayniqsa, yuqori jag‘ va ko‘z
atrofida og‘riq;
•
Bosh og
‘rig‘i, ayniqsa, boshni oldinga egishda
kuchayishi;
•
Isitma (38
–
39°C gacha);
•
Umumiy holsizlik va charchoq.
Diagnostics
The diagnosis of acute purulent sinusitis is primarily
based on clinical evaluation, including a detailed history
and physical examination. Key diagnostic features
include the presence of purulent nasal discharge, facial
pain or pressure, and nasal obstruction. Anterior
rhinoscopy or nasal endoscopy may reveal mucosal
edema, purulent secretions, or obstruction of the sinus
ostia. Imaging studies, such as computed tomography
(CT) of the paranasal sinuses, are reserved for cases
with suspected complications, atypical presentations,
or when surgical intervention is considered. Laboratory
tests, including cultures of nasal secretions, are not
routinely performed but may be useful in refractory or
recurrent cases to identify specific pathogens and guide
antibiotic therapy.
Treatment
The management of acute purulent sinusitis involves a
combination of medical therapies aimed at reducing
symptoms, eradicating infection, and preventing
complications. First-line treatment typically includes
empiric antibiotic therapy, with amoxicillin-clavulanate
being the preferred choice for most patients. In cases
of penicillin allergy or resistance, alternative antibiotics
such as macrolides or fluoroquinolones may be used.
Adjunctive
therapies,
such
as
intranasal
corticosteroids,
saline
nasal
irrigation,
and
decongestants, are often recommended to alleviate
mucosal inflammation and improve sinus drainage.
Analgesics and antipyretics may be prescribed to
manage pain and fever. In severe or complicated cases,
such as orbital or intracranial involvement,
hospitalization and intravenous antibiotics may be
necessary. Surgical intervention, such as functional
endoscopic sinus surgery (FESS), is considered for
patients with recurrent or refractory disease,
anatomical abnormalities, or complications. Patient
education on preventive measures, including proper
nasal hygiene and avoidance of environmental irritants,
is also an integral part of treatment.
CONCLUSIONS
Acute purulent sinusitis is a common yet clinically
significant condition that requires prompt recognition
and
appropriate
management
to
prevent
complications and ensure optimal patient outcomes.
The etiology is predominantly bacterial, often following
viral upper respiratory infections, and its pathogenesis
is closely linked to sinus ostia obstruction and impaired
mucociliary clearance. Clinical diagnosis is based on
characteristic symptoms such as purulent nasal
discharge, facial pain, and nasal obstruction, supported
by physical examination and, when necessary, imaging
studies.
Treatment strategies focus on a combination of
antibiotic therapy, symptomatic relief, and adjunctive
measures to reduce inflammation and promote sinus
drainage. While most cases respond well to medical
management, severe or complicated presentations
may require hospitalization, intravenous antibiotics, or
surgical intervention. Tailoring treatment to individual
patient factors, including age and comorbidities, is
essential for effective care.
Preventive measures, such as proper nasal hygiene and
avoidance of environmental irritants, play a crucial role
in reducing the risk of recurrence. By integrating
accurate diagnosis, evidence-based treatment, and
patient
education,
healthcare
providers
can
significantly improve the quality of life for individuals
affected by acute purulent sinusitis. Further research
into the epidemiology, microbial resistance patterns,
and innovative therapeutic approaches will continue to
enhance the management of this condition.
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