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Sinusitis, inflammation of the paranasal sinuses, is a common disease that may afflict people throughout their lives.
Sinusitis is a common condition, affecting approximately 30% of the population at some point. Sinusitis can occur in infants and children, but is more common in adults as sinuses are undeveloped in infants and start forming during childhood. The average adult has 3-4 upper respiratory infections each year, about 1% of which are complicated by sinusitis. In addition to sinusitis associated with viral respiratory infections, many more people suffer inflammation of the sinuses because of seasonal allergic problems.
The paranasal sinuses are air-filled cavities inside the bones of the skull. They are located on either side of the nose, behind and between the eyes, and in the forehead; there is also one further back in the head. They probably function to reduce skull weight and to enhance vocal resonance. They also have a protective function, as they absorb severe impact from the front and prevent it being transmitted to the brain.
They are lined with mucus-secreting cells, and they warm, moisten and filter air breathed in. Air reaches the sinuses through small openings in the bones (ostia) that connect to the nasal passageways. The mucus-producing cells have small hairlike fibres (cilia) that beat back and forth to help mucus move towards the ostia and out of the sinuses. If these openings become blocked, air can't properly pass into the sinuses and mucus can't drain out. Mucus builds up in the sinus, causing pressure or pain. Also, the mucus is an excellent culture medium for bacteria, and infection can result.
Typically, early in the development of a sinus infection, the cilia lining the sinuses are lost and mucus becomes increasingly thick. Consequently, mucus is retained in the sinus. If the sinus infection lasts long enough, the sinus lining may physically change, causing even thicker mucus to develop. Bacteria become trapped and proliferate. Once this happens, antibiotics will be needed, and possibly surgery.
Sinusitis may be classified based on time span of the problem (acute, sub-acute or chronic), and the type of inflammation (infectious or non-infectious).
The most common complaint is that of a 'sinus headache'. This occurs typically occurs as a result of nasal congestion or sinus mucus which obstructs the ostea, leading to a blockage of air flow and equalisation of air pressure in the sinus and the environment. The air in the sinus is absorbed which causes a negative pressure in the sinus, leading to symptoms of a 'sinus headache'.
Once the obstruction is relieved, the pressure equalises and the sinus headache improves immediately. The second most common cause for sinus symptoms is when the sinus starts producing mucus in response to irritation or constant blockage. At this stage an antibiotic is not usually required. Infection of the sinus usually is accompanied by a temperature, which may suggest that an antibiotic is required.
Call your doctor if:
After your doctor takes a careful history and performs a physical exam, the diagnosis is typically made by the combination of symptoms and the physical examination. Your doctor may look inside the nose with a flexible rubber or rigid steel tube called an endoscope. This is not painful but might be slightly uncomfortable. Your nose is sprayed first with local anaesthetic. Physical findings may include redness and swelling of the nasal passages, purulent (pus-like) drainage, tenderness to percussion (tapping) over the cheeks or forehead region, and swelling around eyes and cheeks.
An X-ray may be done to confirm whether mucous is present in the sinuses. Depending on what is found at the time of the endoscopy, a computerised axial tomography (CAT) scan of your sinuses may be needed. If you need to have surgery, a CAT scan will ordinarily be done prior to surgery. CAT scans and magnetic resonance imaging (MRI) scans are much more sensitive in their ability to diagnose sinusitis, but are expensive.
Rhinoscopy, a procedure for looking into the back of the nasal passages with a small flexible fiber-optic tube, may be used to look directly at the sinus openings and check for obstruction.
It may sometimes be necessary to perform a needle aspiration (drawing of fluid) of a sinus to confirm the diagnosis of sinusitis, and to collect infected material. This will be cultured so the bacteria causing the infection may be identified.
For negative-pressure sinus headaches, an oral decongestant may be all that is required to relieve the headache. If an underlying hayfever is present, then this will need treatment. This may require the addition of a nasal steroid spray.
It is important to treat a sinus infection as soon as it starts. Treatment involves controlling the source of sinus infection, re-establishing proper nasal drainage, and relieving pain.
HomeAgain, for negative-pressure sinus headaches, an oral decongestant may be all that is required to relieve the headache.
Acute sinusitis is usually treated with antibiotic therapy aimed at fighting the most common bacteria known to cause sinusitis, since it is usually not possible to get a reliable culture without aspirating the sinuses.
Commonly used antibiotics such as penicillin, erythromycin and tetracycline may not work if the bacteria have become resistant. Antibiotics such as amoxicillin and sulfa drugs may be used as first-line treatment for uncomplicated acute sinus infections, but commonly do not work in people who have had infections for more than a short period or who have been on multiple antibiotics previously. It may then be necessary to use one of the newer antibiotics.
Because antibiotics penetrate poorly into the sinuses, extended treatment is often necessary. Sometimes several different antibiotics are used until the correct one is found. In some cases multiple antibiotics are used. If you are not improving after five days of treatment with amoxicillin, your doctor may decide to switch you to another antibiotic. Generally an antibiotic must be continued for at least 10 to 14 days. It is, however, not unusual to have to continue treatment for sinusitis up to 6 to 8 weeks. Fungal infections of the sinus are common and a specific treatment for this may be required.
Although antibiotics are important in sinus infection treatment, mucus must be allowed to drain adequately. This is done by using nasal sprays containing small amounts of cortisone to reduce inflammation inside the nose and around the ostia.
Oral decongestants (pseudoephedrine) and mucolytics (guaifenesin), used according to directions for 3 to 7 days, may help with sinus drainage. Nasal decongestant spray should be avoided or used sparingly. Take care to prevent worsening of symptoms or addiction to these sprays.
Rarely, antihistamines are used, but only if allergies play a prominent part in symptoms. Antihistamines can be drying, and should be avoided in sinusitis treatment, if possible. Mucus may dry out and become plastered against the sinus wall, trapping bacteria. People feel better initially while fluid volume in the sinuses is reduced, but eventually symptoms return. A topical nasal steroid spray should reduce swelling in the allergic individual without the antihistamine drying effect.
Treatment of chronic sinusitis requires longer courses of drugs, and may require a sinus drainage procedure.
Approximately two-thirds of people with sinus infections have side effects from medications, including dizziness, difficulty concentrating, jitteriness, rapid heartbeat, difficulty sleeping, nausea, bloating, rectal itching, burning on urination, and fatigue. Several of these symptoms can also be due to sinusitis. It is important to schedule follow-up visits to ensure treatment has been adequate. The most common reason people develop future problems with sinus infections is that they stop medications too soon.
If you are allergic and have chronic or recurrent sinusitis, it may help to get desensitisation allergy injections. Allergy injections are required for 36 months and can start working within six to 24 months, and must be used together with other treatment, including control of exposure to environmental allergy-causing agents.
SurgeryA small percentage of chronic sinusitis sufferers will not improve, even with good medical treatment. In such cases, surgery may be necessary.
The surgery, called functional endoscopic sinus surgery, may be done under local or general anaesthesia. The operation takes approximately 2 to 3 hours. During this time, the surgeon may perform procedures such as straightening the septum, removing tissue from inside the nose, making an opening into the sinus(es) on either side of the nose to improve drainage, and removing some of the inflamed sinus lining. The number of sinuses opened up depends on the nature of your problem. The surgeon inserts a rigid tube (endoscope) into the nose. The entire operation is done through the nose.
You will generally stay in hospital for the day of the operation, or sometimes overnight. You will probably miss 1 to 2 weeks of work. Full recovery may take 6 weeks, although for 6 months to a year you may be more sensitive to infection. If you aren't better at that point, you may have allergies, immune problems, fungal infection of the sinuses, scarring from the original surgery, or sinusitis involving sinuses other than those originally operated on. The surgeon will typically remove crusting from the nose to prevent scarring. For a short period while healing occurs, there will be limitations on lifting, blowing the nose, and flying. Most people don't have a much pain, but if you do, ask your doctor for pain medication.
Having surgery does not necessarily mean you won't get sinusitis again, but it often becomes easier to treat. Once the sinuses are surgically opened, it is possible to wash them out, and as a result, sometimes oral antibiotics become unnecessary. After surgery, it often becomes easier to perform endoscopy and find out exactly where the cause of the problem is.
Treatment of polyps involves steroids, treatment of sinusitis, and treating any allergies. They may sometimes need to be removed surgically, but may come back. They are usually not pre-cancerous.
(Health24.com)