Sinusitis
Sinusitis is an acute or chronic inflammation of the nasal sinuses—hollow
cavities within the cheek bones found around the eyes and behind the nose. The
primary functions of these sinuses are to warm, moisten and filter the air in
the nasal cavity. They also play a role in our ability to vocalize certain
sounds.
Sinusitis, which is common in the winter, may last for months or years if
inadequately treated. Sinusitis can affect the nose, eyes, or middle ear, and
may be indicated by profuse, thick, colored nasal drainage, bad-tasting
post-nasal drip, cough, head congestion and an accompanying headache. Symptoms
may also include a plugged-up nose, a feeling of facial swelling, toothache,
constant tiredness, and occasionally, a fever.
Types and causes of sinusitis
There are two types of sinusitis: acute sinusitis, which is often
caused by a bacterial infection and usually develops as a complication five to
ten days after the first symptoms of a viral respiratory infection such as the
common cold; and chronic sinusitis, which also may be caused by bacterial
infection, but is more often a chronic inflammatory disorder similar to
bronchial asthma.
Although colds are the most common cause of acute sinusitis, those with
allergies may also be predisposed to develop sinusitis. Allergies can trigger
inflammation of the sinuses and nasal mucous linings. This inflammation prevents
the sinus cavities from clearing out bacteria, and increases your chances of
developing secondary bacterial sinusitis. If you test positive for allergies,
your physician can prescribe appropriate medications to control your symptoms,
thereby reducing the risk of developing an infection. People with sinus problems
and allergies should avoid environmental irritants such as tobacco smoke and
strong chemical odors, which may increase symptoms.
Structural problems in the nose—such as narrow drainage passages, tumors or
polyps, or a deviated nasal septum (the wall between the left and right sides of
the nose)—may be another cause of sinusitis. Surgery is sometimes needed to
correct these problems. Many patients with recurring or chronic sinusitis have
more than one factor that predisposes them to infection. So, addressing only one
factor may not be sufficient.
Diagnosis
Even if symptoms seem to be localized to the sinuses, the sinuses are not
always infected. To make a correct diagnosis, a physician will take a detailed
history and perform a physical examination. The physician may also order tests,
if indicated. These tests can include allergy testing, sinus X-ray, CT scans
(which make precise images of the sinus cavities), or a sampling of the nasal
secretions or lining.
The physician also may perform an endoscopic examination. This involves
inserting a narrow, flexible fiber-optic scope into the nasal cavity through the
nostrils, which allows the physician to view the area where the sinuses and
middle ear drain into the nose in an easy, painless, "patient
friendly" manner.
Treatment
Sinus infections generally require a combination of medications. In
addition to prescribing an antibiotic when the sinusitis is caused by bacterial
infection, your physician may prescribe a medication to reduce blockage or
control allergies. This will help keep the sinus passages open. This medicine
may be a decongestant, a mucus-thinning medicine or a cortisone-like nasal
spray. Antihistamines, cromolyn and topical steroid nasal sprays help control
allergic inflammation.
For people with allergies, long-term treatment to control and reduce allergic
symptoms can also be effective in preventing the development of sinusitis. This
treatment may include immunotherapy (also called "allergy shots"),
anti-inflammatory medications, decongestants, and environmental control
measures. Preventative use of low dose antibiotics and sinus drainage
medications during times of increased susceptibility, such as winter, also may
prevent sinusitis.
Several non-drug treatments can also be helpful. These include breathing in
hot, moist air, applying hot packs and washing the nasal cavities with salt
water. In cases of obstructed sinus passages that may require surgery, your
allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat
physician (ENT).
Sinusitis vs. rhinitis
Although many symptoms are similar, sinusitis differs from allergic
rhinitis, known as "hay fever," or non-allergic (vasomotor) rhinitis.
Rhinitis is an inflammation of the mucous membranes of the nose—not the
sinuses. Allergic rhinitis is caused by allergies and is often characterized by
a runny nose, sneezing and congestion, and itchy eyes, nose, throat and inner
ears. Non-allergic rhinitis is characterized by a swollen, inflamed nasal lining
and a stuffy nose. It may be triggered by irritants such as smoke, changes in
barometric pressure or temperature, or overuse of over-the-counter decongestant
nasal sprays. Poorly controlled chronic or recurring rhinitis can lead to
sinusitis.
As you can see, symptoms of sinusitis can vary depending on the severity of
the inflammation and the sinuses involved—all of the symptoms listed above may
be present, or only a few. It’s best to consult your physician promptly if any
of the described symptoms of sinusitis develop.
