SINUSITIS

Definition of sinusitis

Sinusitis is an inflammation or swelling of the linings of cavities called sinuses. These are moist air-filled spaces in the bones of the face surrounding the nose. They are differentiated according to their localization into left or right maxillary, ethmoid, frontal and sphenoid sinuses. Sinuses produce mucus, a fluid that cleans bacteria and other particles of the inhaled air. Tiny hairs called cilia sweep the mucus out of the sinuses so it can drain through the nose. When sinuses become blocked and filled with fluid, germs can grow and cause the infection called sinusitis. Sinusitis can be either acute or chronic if it lasts for more than 4 weeks or recurs frequently.

Frequency and cost of sinusitis

It is estimated that about 37 million people are affected by sinusitis every year in the USA. Although it is not considered as a serious health problem, sinusitis leads to a high number of doctor visits and drug treatments, contributing to nearly 6 billion US$ on health care costs per year, as well as a high number of missed work or school days. Sinusitis occurs after a common cold in about 0.5-2% of the cases. People develop more often sinusitis in the fall, winter and spring. Children under the age of 10 years do not usually develop sinusitis as the sinuses in the forehead don’t start developing until the child is 6 or 7 years old and are not formed enough to get infected until the early teens.

Symptoms of sinusitis

They can include the followings:

• Thick yellow or green stuff that runs from the nose or down the throat indicative of a bacterial origin, while clear secretions are indicative of a viral origin
• Stuffy nose
• Pain or pressure in the forehead, cheeks, teeth, nose, ears or between the eyes
• Unusual bad taste or bad breath
• Reduced sense of taste or smell
• Cough
• Fever and chills
• Tiredness.

Diagnosis of sinusitis

If suspecting an ear infection, it is necessary to visit the doctor, who will make the diagnosis by taking the medical history and doing a physical examination. The proper diagnosis is based on the patient’s symptoms and careful examination of the nasal tissues. Nasal endoscopy, i.e. looking into the nose with a tiny special camera and a telescope, may contribute to confirm the diagnosis. A computed tomography scan of the head and the face provides a detailed image of the sinus structures and may be important for the patients with chronic sinusitis. A sinus X-ray may also be done to confirm a suspected case of sinusitis. A sample of nasal secretions may be performed for analysis the infectious origin: bacterial, viral or fungal. This can also be done by needle puncture and aspiration of sinus contents. A magnetic resonance imaging may be performed if there is a suspicion that the infection has spread beyond the sinuses.

Causes of sinusitis

• Common cold and other viral infections
• Bacterial infection, such as an upper respiratory tract infection
• Fungal infection
• Nasal allergy (allergic rhinitis)
• Hypersensitivity of the lining in the nose and sinuses to different triggering factors.

Risk factors for sinusitis

• Nasal septal deviation
• Nasal polyps blocking sinus passages
• Asthma
• Cystic fibrosis
• Bronchiectasis
• Impaired immune defences
• Immobile cilia syndrome
• Broken nose
• Problems with nasal structure preventing the proper flow of mucus from the sinuses into the nose
• Facial trauma blocking one or several sinuses
• Active or passive smoking
• Overuse of nasal decongestant sprays
• Use of cocaine by the nose
• Air pollution
• Rapid air pressure changes (flying or scuba diving)
• Swimming in contaminated water.

Complications of sinusitis

Although relatively rare, when complications occur they may be severe and require extensive medical or surgical treatment.

• Increased asthma symptoms
• Osteomyelitis: infection of the facial bones
• Meningitis : infection of the lining of the brain and spinal cord
• Spreading of the infection outside sinus, creating a pocket of pus in an eye socket, the brain or facial tissue.

Prevention and treatment of sinusitis

Preventive measures

Several different approaches are available.

• Non specific preventive measures
• Immunostimulants of bacterial origin or other sources (synthetic, thymic extracts) to reinforce the body’s immune defence mechanisms against infections
• Rinsing of the sinus passages with a salt water or saline solution to keep the nasal passages open and wash out mucus and bacteria. Such solutions can be bought over the counter ready to use or ask your doctor on how to make one at home.
• General preventive measures
• Get plenty of rest. Try to lie on the side ant not on the back which can make the sinuses feel more stopped-up, or prop up by using a pillow
• Have a healthy lifestyle with respect to stress, physical exercise and diet
• Drink plenty of fluids, preferably hot, but not alcohol, which can worsen swelling in the sinuses
• During the heating season, use a humidifier to keep home humidity at 45-50% as this will stop dry air from irritating the sinuses and make them more prone to infection
• Apply moist heat by holding a warm and wet towel against the face or by breathing in steam through a towel or from a steamy shower, a hot bath or a sink filled with hot water, as this will help relieve sinus pressure and open sinus passages
• Prevent allergies by avoiding known allergens (pets, pollen, molds, etc) and environmental pollutants and treat them if already present
• Avoid contact with people who have colds or other upper respiratory tract infections and wash hands frequently to prevent germs from spreading
• Avoid active or passive smoking as smoke irritates inflamed sinus membranes.

Medical treatment measures

• Antibiotics are the main approach to relieve symptoms of bacterial sinusitis, but they are not always useful as it is considered that in 3 out of 4 cases sinusitis clears on its own within 4 weeks. Antibiotics are generally given for 7 to 10 days or up to 21 days in case of chronic sinusitis. However, sinusitis is often caused by a virus or a mold, which will not respond to antibiotics but to more adequate treatments such as antiviral or antifungal medications respectively
• Pain relievers such as paracetamol, acetaminophen or ibuprofen to reduce pain
• Decongestants may reduce the swelling of the nasal mucosa, but they should not be used for more than 3 days as they may induce a so-called rebound sinusitis with increased symptoms
• Mucolytics help to thin the mucus for easier draining
• Steroid nasal sprays help to decrease nasal inflammation and mucus production.

Medical treatment measures

If sinusitis fails to respond to the above measures, the doctor may suggest a surgical procedure to open and drain the sinuses as well as correcting structural anomalies of the nose or to remove nasal polyps.

• Functional endocopic sinus surgery: it is a minimally invasive technique using a tiny tube equipped with a camera and a telescope to view the important structure of the nose and sinuses. Obstructing tissue or other pathological factors can thus be removed. It can also be used for sampling sinus secretions in order to determine the origin of the infection and to prescribe the adequate treatment, i.e. the specific antibiotic in case of a bacterial infection.

Any medical information on this website is not intended as a substitute for informed medical advice. No action should be taken before consulting with a healthcare professional.

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