Sinusitis -- types, causes, symptoms, diagnosis, treatment and prevention

If your common cold is making your life miserable due to thick mucus, severe headache and pain around the eyes and cheeks, you have probably developed a sinus infection.

'Sinuses are air-filled pockets present in the skull. They are also present in the facial bones behind the eyebrows, cheeks and jaws. These spaces are lined with tissues similar to that lining the nasal passage and the airways,' says Dr Rohit Vishnoi, Senior Consultant, ENT, Delhi based Sri Balaji Action Medical Institute.

Causes and types of sinusitis

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'Sinusitis is generally caused after a cold or viral infection that causes the sinuses to get inflamed. The tissue lining the sinus spaces become swollen and produces extra mucus. This results in blockage of the nasal passages which may further encourage the growth of bacteria,' explains Dr Vishnoi.

But there are other things that can cause swelling in your sinuses and prevent the cilia (hair like filaments lining the sinus tissue) from moving the produced mucus causing nasal congestion. This can happen due to constant allergic cold, infections due to viruses, bacteria and sometimes fungal spores. People like pilots who are exposed to constant changes in air pressure and temperature can also develop sinusitis. Other causes of sinusitis include:

Presence of a deviated nasal septum (the thin bone separating the nostrils)
Presence of nasal polyps, small fleshy structures developing inside your nose
Recurring infections due to lowered immunity
Use of pacifiers and bottle feeding while lying on the back can cause sinusitis in babies
Smoking and alcohol also cause irritation of the sinuses
Tooth infection or dental procedures like root canals, especially in the upper teeth, can breach in the lining of the sinuses and cause infection

Sinusitis can be of the following types:

Acute sinusitis: Sudden onset of cold-like symptoms that cause facial pain and runny or stuffy nose that continues beyond 8-10 days may lead to acute sinusitis. Acute infection of the sinuses can be caused due to a bacterial infection resulting from an upper respiratory tract infection. It may last for 4 weeks or less.
Subacute sinusitis: Symptoms that continue beyond 4 weeks and last upto 8 weeks can be called a subacute sinus infection.
Chronic sinusitis: When the symptoms last for more than 8 weeks, it is called chronic sinusitis. This long-term inflammation may be caused by bacterial or fungal infection. People allergic to mold, dust and pollen amy suffer from allergic rhinitis and further develop chronic sinusitis.

Symptoms of sinusitis

Primary symptoms of acute sinusitis include:

Pain in the facial bones
Nasal congestion
Thick mucus nasal discharge
Cough and chest congestion that worsens at night
Reduced sense of smell and taste
Sore throat

Other symptoms that may or may not develop include:

Fever
Bad breath
Fatigue
Jaw pain

People with chronic sinusitis may have the following symptoms:

Facial congestion/fullness
A nasal blockage
Pus in the nasal cavity
Fever
Nasal discharge/discolored postnasal drainage

'You should visit a doctor when you having severe headache, fever, pain and tenderness in the frontal area, cheek bones, around eye, dental region after viral rhinitis (nasal infection),' says Dr Vishnoi.

Diagnosis of sinusitis

If you have one or more of the above mentioned symptoms with presence of thick nasal discharge, you're likely to be diagnosed with acute sinusitis. If your symptoms last for a longer period of time, your doctor may perform some physical examination to identify the cause of chronic sinusitis. The doctor may check for the presence of nasal polyps and signs of inflammation. The following tests may be suggested.

Computed tomography (CT) scan to evaluate the anatomy of the sinuses and to determine whether surgery is needed
A magnetic resonance imaging (MRI) scan may be required if the doctor suspects tumor or fungal infection
Nasal endoscopy or rhinoscopy for viewing the sinus spaces through a fiberoptic scope may be done

Treatment and prevention of sinusitis

Dr Vishnoi lists the following medication for treating sinusitis

Antibiotics: They are prescribed to treat bacterial infection of the sinuses, when symptoms don't improve with self care treatment options like steam inhalation
Antihistamines: They may be prescribed in case of acute sinusitis. They relieve sinusitis symptoms caused due to of allergies. But, sometimes you may be advised not to use antihistamines as they can cause excessive drying of the nasal passage and slow the mucus drainage.
Nasal decongestants drops: Some nasal drops that contain anti-inflammatory agents like fluticasone may be prescribed for immediate relief from blocked nose. A few nasal decongestants are also available over-the-counter.
Analgesics: To relieve headache and pain in the facial bone or jaw, pain killers like ibuprofen may be prescribed.

'Surgical treatment is required when the patient fails to respond to medication therapy or when there is blockage of sinus ostium (an opening that connect sinus to the nasal cavity). Surgery may also be done in case of recurring sinusitis' says Dr Vishnoi.

Here are some tips to prevent sinusitis with inputs from Dr Vishnoi.

Drinks lots of water to hydrate yourself and keep mucus thin when you're infected with cold
Try steam inhalation for clearing nasal passage and prevent bacterial infection to develop
Avoid excessive dry environment for preventing complete drying out of the nasal passage
Stay away from airborne allergens like dust and mold if you know you're allergic
Avoid swimming or diving in infected water
Maintain oral hygiene to prevent dental infection or direct trauma to sinuses as in facial fractures.

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