Review Question - QID 102608

This patient is suffering from chronic sinusitis secondary to smoking. Smoking increases the risk of sinusitis by impairing the ciliary function of epithelial cilia lining the sinus.

Cigarette smoking impairs nasal defense mechanisms, including ciliary function, which can lead to mucous accumulation in sinuses. This leads to obstruction which provides a favorable growth environment for bacteria. The symptoms of chronic sinusitis include facial pain, rhinorrhea, and malaise.

Chester writes that initial management should include nonpharmacologic treatments such as increased exercise and nasal steam inhalation. Additionally, lifestyle changes including dietary restrictions, smoking cessation, or a change in environment are typically quite beneficial. Medical therapy such as intranasal corticosteroids, decongestants, anti-inflammatory agents, antibiotics, and, occasionally, antihistamines, offer treatment directed at the causes of chronic sinusitis. Surgery is indicated if all of the above fail.

Elwany et al. studied the effect on the nasal mucosa of children passively exposed to cigarette smoke. They report several structural changes including negative effects on its ciliary activity and mucociliary function. As a consequence, defense mechanisms of the nose may be destroyed, resulting in persistent sinonasal infections. This study is consistent with work done in adults.

Illustration A shows a CT scan of a patient with sinusitis (left) compared to a normal scan. Note the completely occluded right maxillary sinus.

Incorrect Answers:
Answers 1, 2, 3, & 5: Smoking does not lead to immunosuppression, cell necrosis, type 1 hypersensitivity, nor thickening of the ciliary mucous. Thickening of ciliary mucous is the mechanism by which cystic fibrosis causes recurrent sinusitis.