Chronic purulent nasal sinusitis is a disease of chronic inflammation of nasal sinus membrane. As compared to the acute sinusitis, the chronic ones are more often encountered. Among them, the maxillary sinusitis is developed more frequent, it is always accompanied by ethmoidal sinusitis, if only one side or both side of sinus is affected, it is called polysinusitis or pansinusitis; single chronic ethmoidal sinusitis or sphenoidal sinusitis has only minority cases.
The factor of this disease is mainly caused by progression from incorrect or late treatment of acute purulent nasal sinusitis. Other factors are quite similar to the acute purulent nasal sinusitis, infection, allergic nasal sinusitis and disturbances in drainage of nasal sinuses are the main reasons of disease occurrence. The odontogenic (dental) maxillary sinusitis can induce chronic onset of disease.
The causative bacteria (pathogen) of this disease is mostly a mixed infection, recently is more frequent due to flu bacillus, mutated bacillus and streptococcus.
The pathological changes of the disease are very different for each types no matter from inspection of naked eye or microscopical examination; it is often divided into edematous, polypus, soakage, fibrinous, cystical, etc. In fact, it always exists in mixed type with edematous or polypus which is most often can be seen. The sinusal bones may increased in thickness or sparsely separate or assimilated.
1. Purulent nasal discharge: to thick and green or yellowish, volume not constant, excessive flow towards the throat area, some may has bad odour which happened mostly in odontogenic maxillary sinusitis.
2. Nasal congestion: different degree, mainly due to congestional swelling and increased mucosal secretion of nasal membrane, the congestion always leads to temporary disturbances of olfaction.
3. Headache: significant local pain or headache. If there is headache, it often appears as dull pain or heaviness in the head, heavier in day than night. The sinusitis of anterior nasal part yields dull pain or swelling in forehead and root of nose, while sinusitis of posterior nasal part causes pain at upper part of head (calvaria), temporal or occipital part. In odontogenic maxillary sinusitis, it is always accompanied by upper teeth pain at the same side.
4. Others: often accompanied by chronic inflammation of throat (e.g. excessive phlegm, sensation of foreign substances or dryness and pain in throat) due to flow of nasal purulent discharge and long term usage of mouth to breath. If it affects the Eustachio’s tube, it may causes murmurs in the ears, deaf, etc.
Diagnose is due to:
1. Non-complete treatment of acute sinusitis or history of its relapse.
2. Excessive of purulent nasal discharge, odontogenic ones have bad odour and decayed tooth. Nasal congestion, disturbances in olfaction and dull headache.
3. Middle nasal airway has purulent discharge, increased in drainage test.
4. Rhinoscopy reveals purulent fluid, polypus process; nasal sinus X-ray shows a blur picture; maxillary puncture and analysis can help in diagnosis.
Principles of treatment:
1. Pay attention to management of allergic factors.
2. Eliminatet source of infection.
3. Improvement of drainage.
4. Regulation of physiological functions, appropriate surgical intervention.
In traditional Chinese medicine studies, this disease belongs to the category of bi yuan (continuous nasal discharge). The pathological factors are flu, wind and heat of the lungs route, accumulation of heat in gall bladder, moist heat of spleen s route, Qi weakness of lungs and spleen, etc. Clinical types:
1. wind and heat of the lungs route type: significant nasal congestion, yellow or white viscous nasal discharge, large volume, fever, headache, throat slightly uncomfortable, slightly redness of the tongue, white thin or slightly yellow lichen, fu pulse (one type of pulse; there are many types of pulse in Chinese medicine studies).
2. accumulation of heat in gall bladder type: significant nasal congestion, yellow-greenish viscous nasal discharge similar to pus with bad odour, decreased olfaction, headache, strong pain in affected area, along with feeling of heatiness, dryness in oral cavity and throat, frustration, redness of tongue, yellow lichen of the tongue, xuan pulse.
3. moist heat of spleen s route type: significant severe and continuous nasal congestion with large volume of nasal discharge, decreased olfaction with heatiness, heaviness of the head, general body weakness with feeling of heaviness in extremities, dullness in chest, bloating of abdomen, bad appetite, red-yellowish of urine, redness of tongue, thick yellow lichen of the tongue, ru or hua pulse.
4. Qi weakness of lungs and spleen type: more severe significant nasal congestion, large volume of viscous white or sticky yellow nasal discharge, decreased olfaction, dizziness, short of breath (dyspnea), weakness, cough with white phlegm, little food intake but has abdominal bloating, diarrhea, slightly redness of tongue, white lichenof the tongue, weak thready pulse.
5. alternation of heat and accumulation type: significant nasal congestion, mixed type of nasal discharge with bad odour in large volume and yellow coloured, impaired of olfaction, headache, dryness in oral cavity but no temptation of drinking, yellow lichen of tongue, hua pulse.
Clinical treatment results
There were 2000 cases adopted the traditional Chinese medical therapy; 1880 cases fully recovered (symptoms disappeared, x-ray of nasal sinus became normal) and 120 cases shown effectiveness (good nasal drainage, disappeared of purulent nasal discharge, middle nasal airway had small amount of viscous secretion).