Sinusitis

Sinusitis is an inflammation or infection of the sinuses, the air-filled chambers in the skull that are located around the nose. Symptoms of sinusitis include thick nasal discharge, facial pain or pressure, fever, and reduced sense of smell. Depending on how long these symptoms last, sinusitis is classified as acute, subacute, chronic, or recurrent. Viruses are the most common cause of acute sinusitis, but bacteria are responsible for most of the serious cases.

Sinusitis, also called rhinosinusitis, affects about 1 in 8 adults annually and generally occurs when viruses or bacteria infect the sinuses (often during a cold) and begin to multiply. Part of the body’s reaction to the infection causes the sinus lining to swell, blocking the channels that drain the sinuses. This causes mucus and pus to fill up the nose and sinus cavities.

What are Sinuses?

Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. The sinuses stay healthy when the channels are open, which allows air from the nose to enter the sinuses and mucus made in the sinuses to drain into the nose.

Four pairs of sinuses, known as the paranasal air sinuses, connect to the nasal passages (the two airways running through the nose):

• Frontal sinuses (behind the forehead)
• Maxillary sinuses (behind the cheekbones)
• Ethmoid sinuses (behind the nose)
• Sphenoid sinuses (behind the eyes)

Sinusitis occurs if obstruction or congestion cause the paranasal sinus openings to become blocked. When the sinus openings become blocked or too much mucus builds up in the chambers, bacteria and other germs can grow more easily, leading to infection and inflammation.

Types of Sinusitis

• Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold. Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with severe pain around the cheeks, eyes and/or forehead. This may be associated with swelling and a high fever along with toothache.

 

• Chronic sinusitis is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.

 

Causes

Infections – Most adults will get colds and upper respiratory tract infections up to three times a year. Children get them more frequently. Bacterial infections often follow the common cold. When the mucus changes from clear to yellow or green it usually means a bacterial infection has developed. Both viral and bacterial infections cause swelling of the tissues inside the nose and thickening of the normal mucus. This slows down or even stops proper sinus drainage and infection in the sinus may ensue.

Irritants – Air pollution, smoke and chemical irritants, for example some sprays containing pesticides, disinfectants and household detergents, may cause swelling and blockage of the lining of the nose causing a narrowing of the drainage opening from the sinuses. This can once again lead to impairment of sinus drainage and consequent infection.

Allergies – Allergies can cause inflammation inside the nose. Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control.

Structural problems – Occasionally structural problems within the nasal cavity can cause a narrowing. Some of these can be caused as a result of trauma while others may develop during the growth period. Occasionally the structural narrowing can be so severe that mucus builds up behind these areas of blockage giving rise to sinus infection.

Risk Factors

• Certain factors increase a person’s susceptibility to sinusitis, including:
• Frequent colds (especially for young children)
• Cigarette smoking (active or passive)
• Regular use of nasal decongestant sprays (for more than two to three days)
• Untreated hay fever or other allergies
• Structural abnormalities of the nose
• Nasal polyps (swellings in the linings of the nose or sinuses)
• Dental disease, such as untreated tooth abscess.

Symptoms

Common symptoms of sinusitis include –

• Postnasal drip
• Discolored nasal discharge (greenish in color)
• Nasal stuffiness or congestion
• Tenderness of the face (particularly under the eyes or at the bridge of the nose)
• Frontal headaches
• Pain in the teeth
• Coughing
• Fever
• Fatigue
• Bad breath

Sinus disease is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.

Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus disease. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinus disease that is not caused by infection. Appropriate treatment of sinus disease often improves asthma symptoms.

Complications

Asthma flare-ups – Chronic sinusitis can trigger an asthma attack.

Meningitis – This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.

Vision problems – If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Aneurysms or blood clots – Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain and putting you at risk of a stroke.

Osteomyelitis – Adolescent males with acute frontal sinusitis are at particular risk for severe problem. n such cases, the patient usually experiences headache, fever, and a soft swelling over the bone known as Pott’s puffy tumor.

Treatment

Antibiotics – Antibiotics are standard treatments for bacterial sinusitis. Antibiotics are usually taken from 3 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases. Antibiotics help eliminate sinus disease by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal decongestant sprays – Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.

Antihistamines – Antihistamines block inflammation caused by an allergic reaction so they can help to fight symptoms of allergies that can lead to swollen nasal and sinus passages.

Nasal decongestants and antihistamines – Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your doctor.

Topical nasal corticosteroids – These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinusitis. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing “addiction.”

Nasal saline washes – Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery – If drug therapies have failed, surgery may be recommended as a last resort. It is usually performed by an otolaryngologist. Anatomical defects are the most common target of surgery.

Alternative Treatment

Bromelain – Several studies suggest that bromelain, an enzyme derived from pineapples, may help reduce inflammation and swelling and relieve symptoms of sinusitis.

Quercetin – Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables.

Probiotics – Probiotics, or “friendly” bacteria, may be helpful if you are taking antibiotics for sinusitis. They may also reduce your chances of developing allergies. Probiotics may not be appropriate for certain people who are extremely immunocompromised or who take immunosuppresent drugs.

N-acetylcysteine – NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. It also helps thin mucus.

Sinupret – The herbs it contains may work by thinning mucus and helping the sinuses drain, and they may also help strengthen the immune system.

Chiropractic – Although no studies have examined using chiropractic to treat sinusitis, some practitioners suggest it may decrease pain and improve sinus drainage for some people.