REVIEW – March 2008

Rhinosinusitis as a cause of facial tenderness and pain sensation


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Rhinosinusitis is one of the most common causes for nasal and facial tenderness or pain sensation. Rhinosinusitis is defined as the inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), + facial pain/pressure, + reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from the middle meatus and/or, oedema/ mucosal obstruction primarily in the middle meatus, and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses. A fundamental role
in the pathogenesis of rhinosinusitis is played by the ostiomeatal complex, the key element being there maintenance of the ostial patency. Emphasis is laid on early recognition of the predisposing factor in development of sinusitis along with early diagnosis so that appropriate and aggressive medical therapy can be instituted early to control the acute suppurative disease. Surgical management can be performed to facilitate drainage of the involved sinuses. Complications of rhinosinusitis are possible but infrequent and necessitate aggressive medical and at times surgical management. Patients with the chronic disease need mostly surgery (FESS). To avoid chronic rhinosinusitis development in children, it is essential to fi nd out and remove all the predisposing factors such as adenoid hypertrophy, gastro-oesphageal reflux, conchal hypertrophy, etc.