Tamil Nadu - Chennai

Paradigm shift in diagnosis of sinusitis Health & Lifestyle

CHENNAI: The understanding of few diseases has undergone as radical a change in concept, diagnosis and treatment as that of sinusitis.

In contrast to the under-diagnosis of most diseases, sinusitis has been an over-reported condition as the common practice was to suspect every other headache to be a condition of inflamed para-nasal sinuses. “Sinusitis has been wrongly linked to 80 per cent of headaches,” said Janakiram, managing director of Royal Pearl Hospital in Tiruchi, who was in Chennai recently to receive an award for his research efforts in frontal sinusitis.

Sinusitis can be classified as an environmental disorder with seasonal lifecycles (during rains). Most commonly, the onset involves a bacterial attack leading to the inflammation of the nasal mucous membrane. The block in the ostium (opening of the sinus) produces an accumulation of secretions associated with oedema and pain.

“We are seeing significant increase in the number of allergy-triggered sinusitis cases,” said Ravi Ramalingam, consultant, KKR ENT Hospital. This incidence is correlated to the pollution levels in the city where air quality is sullied by a cocktail of vehicle emissions, cotton dust, animal dander, pollen of the Parthenium weed, fungal molds and spores, he said.

ENT specialists say that over the years, sinusitis management has undergone dramatic change at the perceptive, diagnostic and therapeutic levels.

From the crude practice of pulling out a tooth to create a fistula and drain out the pus, endoscopic sinus surgery has evolved into a fine-grained sub-speciality ready to advance into the robotics era.

Recurrence rates and residual problems have come down sharply with the increasing availability of ENT surgeons who have specialised in endoscopic sinus surgery, said Dr. Ramalingam.

ENT specialists now know that rather than the gravity that was once believed to drive the pus out, the pathogenesis is believed to be rooted in the alterations in nasal mucociliary clearance. Today, an ENT surgeon would use a nasal endoscope and prefer a CT scan over an X-ray to draw a conclusion.

ENT surgeons say they are also coming across a shift from bacteria-triggered sinusitis to fungal sinusitis because of widespread use of antibiotics to treat various infections. The World Rhinology Society has now set new benchmarks for evaluating a case of acute or chronic sinusitis.

And, in the new set of stringent criteria for diagnosing sinusitis, the headache has been relegated as a minor factor.

In short, the differential diagnosis for sinusitis has been put down into mathematical scores and grades, said Dr. Janakiram, who has trained under doyens of rhinology in the West.

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