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Chronic Sinusitis
O P Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
 

Sinusitis is a definite entity and at times could be dangerous if not treated vigorously. In the past, I have often written that ENT specialists and GPs label patients having simple allergic rhinitis as sinusitis which is a wrong diagnosis. In this article, I want to impress that there is a real entity of sinusitis, which possibly, an average GP may not see in his lifetime.

Chronic sinusitis : Though acute sinusitis is often seen in private practice with patients having purulent nasal discharge and ache over the sinuses, in chronic sinusitis the only symptoms may be:

  1. Aches, pains and tenderness over the sinuses, the infection mainly migrating from a bad infected tooth, so much so that the closest differential diagnosis is a bad tooth and not an infected sinus.
  2. PUO may be the only presentation of chronic sinusitis and even X-ray may not help in the diagnosis. It is the CT scan, which will confirm the diagnosis and exclude malignancy which is a close differential diagnosis.
Finally there are 3 conditions to be remembered, where chronic sinusitis should be excluded by CT scan:
  1. HIV patients having PUO where no other cause is found.
  2. Wagner’s Granulomatosis: Patients can have bad sinusitis.
  3. Aspergillosis is one of the fungi, which if attacks the upper respiratory tract, can cause chronic sinusitis. The patient will need expensive anti-fungal drugs and the help of an endoscopist ENT surgeon.

 
 

SMOKING AND WEIGHT GAIN
‘Smoking cessation is beneficial for lung function, but maximum benefit needs control of weight gain, especially in men’ Although stopping smoking improves lung function, accompanying weight gain can offset this benefit somewhat. To estimate the net effect, Susan Chinn and others did a follow-up study of 6654 people for whom information about smoking and lung function had been measured. The net result of smoking cessation was a similar improvement in lung function for men and women, although the negative effect from weight gain was greater for men than for women. The authors conclude that weight control would maximise the benefit from stopping smoking. In a comment, Graham A Colditz and Cynthia Stein discuss possible mechanisms of weight gain and ways to counter them.
BMJ, 2005; 330 : 1600, 1629.

 
 
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