Sinusitis

What is sinusitis?

Sinusitis is an infection of the paranasal sinuses that occurs due to obstruction or bacterial growth. Among the many causes of such obstruction or congestion are common cold, allergies, certain medical conditions, and abnormalities in the nasal passages. Sinusitis develops as follows:

• Mucous drainage and airflow are blocked.
  
• Secretions build up, encouraging the growth of certain bacteria.
  
• The resulting infection, swelling, and inflammation create further blockage, which may cause the sinuses to close up completely.

What are the different forms of sinusitis?

Sinusitis is usually defined as acute, recurrent acute, or chronic.

• Acute sinusitis is the most common form. Nearly everyone experiences it at one time or another. It lasts no longer than eight weeks or occurs less than four times a year with each attack lasting no longer than 10 days. Acute sinusitis can be successfully treated with medications, leaving no residual damage to the mucous linings.
  
• Recurrent acute sinusitis occurs more frequently but leaves no significant damage.
  
• Chronic sinusitis lasts for eight weeks or longer (12 or longer in children) or occurs more than four times a year (six times in children) with symptoms persisting for more than 20 days. In cases of chronic sinusitis, imaging techniques show mucous tissue damage.

Chronic and recurrent acute sinusitis can be lifelong conditions.

What causes sinusitis?

Bacteria are the most common direct cause of acute sinusitis. The ability of bacteria or other agents to infect the sinuses, however, must first be set up by conditions that create a favourable environment in the sinus cavities. The cause for chronic sinusitis cases are sometimes unclear.

What are the conditions leading to chronic or recurrent sinusitis?

Chronic or recurrent acute sinusitis typically results from one of the following conditions:

• Untreated acute sinusitis that results in damage to the mucous membranes.
  
• Chronic medical disorders that cause inflammation in the airways or persistent thickened stagnant mucous. Some of these include diabetes, AIDS or other disorders of the immune system, hypothyroidism, cystic fibrosis, Kartagener's syndrome, and Wegener's granulomatosis.
  
• Structural abnormalities.

What are the symptoms of sinusitis?

The symptoms of sinusitis may include:

• Nasal congestion and obstruction
  
• Chronic cough (day and night)
  
• Bad breath
  
• Postnasal drip (which can cause repeated throat clearing)
  
• Facial tenderness or pressure may be present. Sufferers do not usually experience facial pain unless the infection is in the frontal sinuses, which usually results in a dull, constant ache.

How is sinusitis diagnosed?

A patient who has sinusitis symptoms that do not clear up within a few days, are severe, or are accompanied by high fever or acute illness should see a physician.

The first goal in diagnosing sinusitis is to rule out other possible causes of symptoms, and then determine the following:

• The site where the infection has occurred
  
• Whether the condition is acute or chronic, and
  
• The organism causing the infection (if possible).

True bacterial sinusitis can usually only be definitively diagnosed using expensive procedures and imaging techniques. Fortunately, such procedures are rarely needed, since most cases of sinusitis are mild.

How is acute sinusitis treated?

The primary objectives for treatment of sinusitis are reduction of swelling, eradication of infection, draining of the sinuses, and ensuring that the sinuses remain open.

Home remedies that open and hydrate sinuses may, indeed, be the only treatment necessary for mild sinusitis that is not accompanied by signs of acute infection.

• Drinking plenty of fluids and taking rest when needed is still the best bit of advice to ease the discomforts of common cold. Water is the best fluid and helps lubricate the mucous membranes.
  
• Hot soups do indeed help congestion. The hot steam from the soup may be its chief advantage. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
  
• Spicy foods that contain hot peppers or horseradish may help clear sinuses.
  
• Inhaling steam two to four times a day is also very helpful, costs nothing, and requires no expensive equipment. A mentholated or other aromatic preparation may be added to the water. Long, steamy showers, vaporizers, and facial saunas are good alternatives.

Many people take medications to reduce mild pain and fever. Adults most often choose aspirin, ibuprofen, or acetaminophen.

A nasal wash can be helpful for removing mucous from the nose. A saline solution can be purchased at a drug store or made at home. Decongestants administered in nasal spray form may be used for short-term treatment. They thicken secretions in the nasal passages however, and may reduce the ability to clear out bacteria. Expectorants, which are drugs that cause mucous to be coughed up from the lungs and may help promote draining and reduce tissue swelling, are sometimes recommended for treatment of sinusitis. Expectorants generally contain ingredients that thin mucous secretions called mucolytics. The most common mucolytic used is guaifenesin, which may cause drowsiness or nausea.

What are the surgical procedures for chronic or recurrent sinusitis?

Surgery is used to unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis.

The simplest surgical approach is the insertion of a drainage tube into the sinuses followed by an infusion of sterile water to flush them out. In the past few years there has been a major advance in the surgical treatment with a minimally invasive technique called functional endoscopic sinus surgery (FESS). The procedure allows correction of obstructions, including any polyp and ventilation and drainage to aid healing. Endoscopy is now used in most cases of chronic sinusitis, but in severe cases, invasive surgery using conventional scalpel techniques to remove infected areas may be required. This may be the case with acute ethmoid sinusitis in which pus breaks through the sinus and threatens the eye, with very severe frontal sinusitis, with invasive fungal sinusitis, or when cancer is present in the sinuses.