In the bones around the nose, there are hollow areas called sinuses, which are connected to the nose by slender, tiny channels. When the channels are open, air from the nose can enter the sinuses and mucus produced in the sinuses can drain into the nose, maintaining sinus health is possible. An inflammatory disorder affecting the four paired structures that enclose the nasal cavity is referred to as sinusitis. A respiratory epithelium lines each sinus, producing mucus that is expelled by cilliary action through the sinus ostium and into the nasal cavity. Inflammation in the sinuses causes sinusitis, often known as sinus infection or rhino sinusitis. Although there is no exact description in the Unani system of medicine, the symptoms are more or less the same as nazla and zukam.

Most eminent intellectuals and medical professionals differ in their opinions. The nazla is a condition in which the nasal mucosa becomes inflamed and is always associated with excessive nasal discharge, according to the father of medicine Buqrat [Hippocrates], whereas zukam is a nazla of the nasal mucosal lining. According to renowned Unani scholar Samerqandi, nazla is the condition in which mucus drips into the nasal cavity, and ukam is the condition in which mucus drips down the throat.The term nazla is derived from the Arabic word Nazool, which meaning to descend, according to Gulam Geelani, another scholar of the Unani religion. In his work “Alqanoon Fit Tib,” Ibn Sina divided nazla and zukam into two distinct sickness categories. He asserts that both nazla and zukam display the complex condition, or the expulsion of madda from the brain. Zukam was also described by Hakeem Abdul Hassan Bin Ahmmad Tabri and Ali Abni Abbas Majoosi as a syndrome characterised by the accumulation of ratoobat (secretions) from the brain’s jauf and batan (ventricles), as well as discharges from the eyes, ears, and nose.

Prevalence

The most common diagnosis for which antibiotics are recommended is it. Acute sinusitis of viral or bacterial ethology is diagnosed in the US annually in more than 20 million cases across all age categories, impacting around 16 percent of the adult population and leading to nearly 12 million office visits. Acute bacterial sinusitis develops from viral upper respiratory tract infections in between 0.5 and 13% of cases. By the time they are three years old, 6 to 13 percent of children will have experienced one bout of acute sinusitis. School-aged children experience 6 to 8 upper respiratory tract infections on average each year, and 5 to 10% of these illnesses are worsened by sinusitis.In the USA, there were 24 million patient visits for chronic sinusitis in 1992.

Clinical Features

Depending on how intense the inflammatory process is and how well the ostium drains the exudate.

Constitunal Symptoms in Acute Sinusitis

1. Body discomfort, general malaise, and fever.

Headache

1. Maxillary Sinus:-Since the headache just affects the forehead, frontal sinusitis may be mistaken for it.
2. Frontal Sinus: Typically, a severe headache will be limited to the damaged sinus. It exhibits a recognisable regularity, i.e., it appears while walking, grows progressively, reaches its height around midday, and then begins to fade. It is also known as a work headache.
3. Sphenoid Sinus: The occiput or vertex is typically the location of a headache.

 Pain

1. Maxillary Sinus: This sinus is usually found above the upper jaw, however it can also relate to the gums or teeth. Stooping, coughing, or chewing can make pain worse.
2. Frontal Sinus: Pain is caused by upward pressure on the frontal sinus’s floor, which is located directly above the medial canthus.
3. Ethmoidal Sinus: This sinus is situated deep to the eye and medially above the nose bridge. The movement of the eyeball makes it worse.

Post Nasal Discharge

1. In the middle meatus of the maxillary sinus, an anterior rhinoscopy reveals pus or mucopus.
2. Frontal Sinus: The anterior portion of the middle meatus is visible high up with an avertical streak of mucopus.
3. Ethmoid Sinus: During an anterior rhinoscopy, the middle or superior meatus may show signs of pus. Depending on whether the rear or anterior set of ethmoid sinuses are involved.

Oedema of Upper Lid

1. Maxillary Sinus: Children frequently have redness and oedema of the cheeks, and the lower eyelid may swell.
2. Frontal Sinus: Upper eyelid oedema with suffused conjunction and photophobia are symptoms of the
3. Ethamid Sinus: Both eyelids swell and puff out.

Constitunal Symptoms in Chronic Sinusitis

• Nasal obstruction, Blockage, Congestion and .
• Nasal discharge of any character from thin to thick and from clear to purulent.
• Post nasal
• Facial fullness, discomfort, pain and head
• Chronic unproductive
• Hyposmia or
• Sore throat.
• Dental
• Visual
• Stuff
• Impleasent
• Fever of unknown origin.
• Fotid breath

Etiology

Noninfectious causes include

• Allergic rhinitis with mucosal oedema or polyp blockage.
• Barotrauma (from deep-sea diving or flying).
• Irritating chemicals.
• Tumors of the sinus and nose.
• Granulomatous conditions.
• Nasal packing.
• A divergent septum.
• Turbinates that are hypertropic.
• Nasocomial sinusitis in intensive care units is significantly increased by nasotracheal intubation.

Infectious Causes Include

• Viruses (including influenza, parainfluenza, and rhinovirus).
• Between 50 and 60 percent of cases are bacterial (S.pneumoniae and lipable hemophilies).
• Moraxella catarrhalis infects 20 percent of infants and causes illness, although it is less common in adults.
• Molar or premolar dental infections or their extraction may be required through acute sinusitis

Predisposing Factor

Environmental:-Cold, humid climates are conducive to sinusitis. Sinus infections are also made more likely by atmospheric pollution, smoking, dust, and crowdy places. Nutritional inadequacies, recent exanthematous fever attacks (measles, chicken pox, whooping cough), poor overall health, and systemic diseases (diabetes, immune deficiency syndrome)(Nowshahri, 2019)

Pathophysiology of Acute Sinusitis

Pollutants, bacteria, dust, and other antigens are filtered out by the function of the sinuses. Small passageways termed ostia are used by sinuses to drain into the intranasal meatus. The middle meatus, which is a crowded region known as the osteomeatal complex, receives drainage from the maxillary, frontal, and anterior ethmoid sinuses. The superior meatus is the drainage point for the posterior ethmoid and sphenoid sinuses. The mucous membranes that line the nasal cavity and nasopharynx are lined with tiny hairs called “cilia,” which function in an integrated and coordinated manner to circulate mucus and filtered debris until they reach the nasopharynx and oropharynx, where they are swallowed. When the sinuses and nasal passages are unable to efficiently filter away these antigens, an inflammatory condition known as rhinosinusitis results.Three main causes—obstruction of the sinus ostia (i.e., anatomical causes such as a tumour or septal deviation), ciliary dysfunction (i.e., Kartagener syndrome), or thickening of sinus secretions—typically contribute to this illness (cystic fibrosis). Local edoema brought on by upper respiratory tract infections (URI) or allergies to nasal secretions, both of which increase the risk of rhinosinusitis, is the most frequent cause of temporary obstruction of these outflow regions. When this happens, microorganisms may stay inside the normally sterile paranasal sinuses, enter them, and grow there. When the sinus infection spreads to other regions including the brain and orbit via the valve-less diploic veins, serious consequences may result. These veins are found in the skull’s inner layer of cancellous bone. Thankfully, this is a rare occurrence, but it is still vital to keep in mind.

Adults have four fully developed sinus chambers that are paired. the frontal, maxillary, ethmoid, and sphenoid sinuses. Only the ethmoid and maxillary sinuses are present in newborn children. Only a tiny amount of bone divides the orbit from the ethmoid sinus (the lamina papyrecia). Therefore, the ethmoid sinus, which appears more frequently in young infants, is the primary cause of orbital infections. The frontal sinuses do not fully develop until after puberty and do not appear to begin to grow until 5 to 6 years of age. The frontal sinuses are often the source of intracranial problems, which are more common in older kids or adults.The sphenoid sinus starts to pneumatize at 5 years of age but does not fully develop until 20 to 30 years of age.(DeBoer and Kwon, 2019)   

Unani Causes and Factors of Sinusitis

The majority of Unanischolars have identified both extrinsic [external environmental variables] and internal [body-related elements] causes of sinusitis.

Extrinsic Factors

The majority of Unanischolars have identified both extrinsic [external environmental variables] and internal [body-related elements] causes of sinusitis.

• Contact with a chilly, humid atmosphere.
• Environmental conditions that are excessively hot and dry, excessively hot and wet, or excessively cold and dry.
• Either a diet that may make them more severe in their temperament or one that may make them even more imbalanced in their temperament.
• Extrinsic factors include microbes such as bacteria, viruses, fungus, etc.
• This category also includes local irritants including pollen, cotton, fur, feathers, dust, grit, and soil particles.

Intrinsic Factors

• Phlegmatic Balgami Mizaj people are more likely to have the condition due to inherent characteristics.
• Safravi mizaj persons also have this illness because madda raises internal body temperatures from normal to extremely high, which congests the brain and causes secretions from both ventricles to start leaking from the nose. (8) Damvi and sodavimizaj patients hardly ever acquire this illness.

When infectious, sinusitis is often categorized by the offending pathogen type (viral, bacterial, or fungal) and the length of the illness (acute vs. chronic).

Types of Sinusitis

Acute Sinusitis

The vast majority of sinusitis instances are those with a duration of fewer than four weeks, according to this definition. Any patient with an upper respiratory tract infection that lasts longer than 7 to 10 days should be suspected of having acute sinusitis, especially if the illness is severe and is accompanied by a high fever, purulent nasal discharge, or periorbital oedema. If it lasts less than four weeks, it is classified as acute rhino sinusitis, and if it lasts more than 12 weeks, it is classified as chronic rhino sinusitis.

Acute sinusitis typically develops as a side effect of acute rhinitis, and dental sepsis seldom causes it. The sinuses are filled and the ostia are closed due to swelling and inflammation. Mucocele causes the sinus to fill with pus, which leads to an empyema. Acute sinusitis is the medical term for acute sinus mucosal inflammation. The maxillary sinus is the one that is most frequently affected, followed by the ethmoid, frontal, and sphenoid sinuses; this condition is known as poly sinusitis. Sometimes [pansinusitis unilateral or bilateral] both sides’ sinuses are simultaneously affected.

Chronic Sinusitis

Chronic sinusitis is defined by sinus irritation symptoms that last for longer than 12 weeks. It may begin abruptly as an acute sinus infection or upper respiratory tract infection that does not go away, or it may develop slowly and insidiously over months or years. Patients with a history of nasal polyposis and asthma are more likely to develop allergic fungal sinusitis, the third type of sickness.(Nowshahri, 2019

Sinusitis diagnosis

Before making a diagnosis, a doctor will inquire about your symptoms and do a physical examination. They might push a finger against your head and cheeks to feel for pressure and soreness. Additionally, they could check your nose’s interior for indications of inflammation.

Based on the basis of your symptoms and the findings of a physical examination, the doctor can typically determine that you have sinusitis.

The doctor could advise imaging studies to check your sinuses and nasal passageways if you have persistent sinusitis. These examinations can detect polyps and any abnormal formations, such as mucus blockages.

Imaging tests

A diagnosis may be made using a variety of imaging studies.

• An X-ray gives you a clear picture of your sinuses.
• A CT scan gives you a three-dimensional image of your sinuses.
• Strong magnets are used in MRIs to produce images of interior structures.

Endoscopy of the nose

The inside of your sinuses and nasal tubes can be seen clearly by the doctor using a fiberscope, a lit tube that enters through your nose. During this process, a doctor could collect a sample for culture testing. Testing for viruses, bacteria, or fungi using cultures is possible.

Asthma testing

A test for allergies finds potential allergens in the surroundings.

Blood analyses

A blood test can check for illnesses like HIV that compromise the immune system.(Higuera, 2022)

Principles of Treatment (Usuool-e- Ilaj)

• Izala-e- sbab (Elimination of the cause)
• To increase body temperature (Taskheen-e-Raas) and prepare the causative substance for evacuation. (Nuzj-e- Mawaad)
• To remove the barrier (Tafteeh-e- Sudda)
• To eliminate the root cause (Tanqiya-e- mawaad)
• To exercise the brain (Tqwiyat-e- Dimaagh)

Regimenal Therapy (Ilaj Bil Tadbeer)

• It is advantageous to irritate (Daghdagha) the nostrils.
• Takmeed (fomentation) with a heated cloth and Inkebaab (steam inhalation) are both recommended.
• If damavi khilt (sanguine) is present, facsd (venesection) is advised, and it should be followed by mushilat (Purgative drugs).
• The use of lukewarm shineez and zeera to elicit sneezing is highly effective.
• Drinking lukewarm water is quite beneficial.

Dietary recommendation

• Aghziya Musakhkhinah
• Ma-ul- Asl
• Ma-ul- Sha’eer
• Aghziya Lateefa

Dietary Restrictions

• Excessive food consumption is prohibited
• Additionally forbidden is fatty food
• Cold foods (Aghziya Baarida) are likewise prohibited
• As also, heavy food is prohibited.nhp(Khan, 2019)

Single drugs for Sinusitis

• SAPISPOST KHASHASH [somniferous seeds]
• GAOZABAN [borage officinalis]
• BEEHIDANA [cydona oblanga]
• TAN [cardolia latifolia]
• KHAKSI [sismbrium lotus]
• UNNAB [ziziphus jujuba]
• TUKHM KHASHASH [papaver]

Compound Drugs [Murakabats]

• Itrifil ustakhudoos
• Sharbat banafsha
• Sharbat gaozaban
• Laooq sapistan
• Habi shifa (Nowshahri, 2019)

Sinusitis prevention

A healthy lifestyle and limiting your exposure to germs and allergens will help prevent this inflammation because sinusitis can appear after a cold, the flu, or an allergic reaction.

To lower your risk, you can

• To lower your risk you can: “Get a flu shot every year”.
• Consume healthy foods like fruits and veggies.
• Wash your hands often.
• Reduce your exposure to pollen, pesticides, smoking, and other irritants or allergies.
• To treat allergies and colds, take antihistamines.
• Avoid being around persons who are contagious respiratory illnesses like the flu or the common cold.(Higuera, 2022)

COMPLICATIONS OF CHRONIC SINUSITIS

1. Intracranial complications
2. Orbital complications
3. Osteomyelitis
4. Descending infection
5. Focal infection

1. Intracranial Complications

Due to their close ties to the cranial fossa, the frontal, ethmoidal, and sphenoidal sinuses are susceptible to infection, which can result in:

• Meningitis
• ESubdural abscess
• Brain abscess
• cavernous sinus thrombosis
• ncephalitis
• Extradural abscess

2. Orbital Complication

The ethmoid, frontal, and maxillary sinuses are connected to the orbit and its contents by a thin membrane or bone lamina called the Lamina Papyracea, however the majority of difficulties result from ethmoid infection.

Orbital complications consist;

• Inflammatory oedema of lids.
• Orbital cellulites
• Orbital abscess
• Subperiosteal abscess.

3. Osteomyelitis

Osteomyelitis, an infection of the bone marrow, affects the frontal and maxillary sinuses, which contain the marrow. osteitis, an inflammation of a dense bone.

4. Descending Infections

Discharge from suppurative sinusitis frequently enters the pharynx and can increase or cause symptoms.

• Otitis media
• Persistent laryngitis
• Pharyngitis Tonsillitis

5. Focal Infections

• Tenosynovitis
• Polyarthritis
• (Reza et al.)

References

DEBOER, D. L. & KWON, E. 2019. Acute sinusitis.

HIGUERA, V. 2022. What You Need to Know About the Four Types of Sinusitis [Online]. Available: https://www.healthline.com/health/sinusitis [Accessed 07/04/22].

KHAN, D. M. A. 2019. Chronic Sinusitis (Waram-e-Tajaweef-e- Anf Muzmin) [Online]. Available: https://www.nhp.gov.in/chronic-sinusitis-waram-e-tajaweef-e-anf-muzmin_mtl [Accessed 07/04/22].

NOWSHAHRI, D. A. F. 2019. Unani Perspective of Sinusitis (Iltihab e Tajaweef e Anaf): A Literary Review. International Journal of Science and Research (IJSR), 8

REZA, M. S., AHMAD, M. R., RAHMAN, M. N. & ALAM, M. T. Iltihab-E-Tajaweef-E-Anaf Muzmin (Chronic Sinusitis)-A Review.