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Sinusitis

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Sinusitis is a condition wherein the sinuses become infected or inflamed (swollen). Sinuses are the hollow, air-filled spaces in the head, particularly in the bones behind the eyebrows and cheeks. The four pairs of sinuses, along with their location in the head, are as follows:

  1. Ethmoidal sinuses - between the eyes
  2. Sphenoidal sinuses - behind the eyes
  3. Maxillary sinuses - below the eyes
  4. Frontal sinuses - above the eyes

These cavities are connected by narrow channels. These sinuses are lined by the same tissues that line the inner wall of the nose. The sinuses produce mucus that drain from the nose channels and remove the foreign particles and bacteria from the inhaled air.

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However, when conditions such as infections or allergies cause swelling in the nose, the same condition can affect the sinuses too. Swelling of the tissues that line the sinuses increases the production of mucus. Subsequently, the sinuses may get blocked and form a breeding ground for bacteria, resulting in an infection.

 

Types

Sinusitis is classified into the following four types based on the time frame of symptoms:


  1. Acute sinusitis: Persists for up to four weeks

  2. Subacute sinusitis: Persists for four to 12 weeks

  3. Chronic sinusitis: Persists for more than 12 weeks

  4. Recurrent sinusitis: Symptoms occur multiple times in a year

Symptoms

The common symptoms of sinusitis are as follows:


  • Headache

  • Fever

  • Blocked nose

  • Coughing, which usually gets severe during night-time

  • Reduced sense of taste and smell

  • Pain in the forehead, cheeks, ears, nose or between the eyes

  • Bad breath

  • Toothache

  • Weakness

  • Swelling around the eyes

  • Sore throat

  • Mucus dripping down the back of the throat

Causes And Risk Factors

Causes

Sinusitis is usually caused due to a cold or an allergy that causes the lining of the nose and sinuses to swell and block the flow of mucus. Bacteria or viruses may then reside and grow inside the sinuses and causes headache, pain and, in some cases, fever. Other factors that may cause sinusitis include:


  • Deviated septum (septum is the straight, cartilage wall that divides the nasal passage; a deviated septum is the condition wherein the septum is not straight or is inclined to one side of the nose)

  • Growths in the nose or sinuses

  • Illnesses or medicines that weaken the immune system


Sinusitis caused due to viruses or bacteria are called sinus infections. Sinusitis caused due to viruses is contagious, while those caused by bacteria is non-contagious.

Risk Factors

People with the following habits or conditions are at an increased risk of sinusitis:

  1. Active or passive cigarette smoking

  2. Abnormalities in the structure of the nose

  3. Untreated allergies or dental diseases

  4. Frequent use of nasal decongestant sprays, especially when used for more than two or three days

  5. Swelling in the lining of sinuses or the nose

  6. Frequent colds

  7. Swimming or diving

Prevention

Sinusitis cannot be prevented. However, people who are especially at risk can take certain measures listed below to keep themselves healthy and minimise the risk of sinusitis:


  1. Those prone to allergies should stay away from irritants that trigger allergies.

  2. Smokers should stop smoking. People should also avoid second-hand smoke.

  3. People should wash their hands regularly and avoid touching the face, especially during the common cold season, to avoid infections.

  4. Avoid exposure to irritating fumes and tobacco smoke.

  5. People with colds should properly blow their noses to prevent bacteria from accumulating inside the sinuses. The best way recommended to blow the nose is:

    1. Use a nasal rinse to loosen the mucus or any other material

    2. Gently blow one side of the nose at a time



Diagnosis

A doctor diagnoses sinusitis based on the following:


  1. Asking questions about the symptoms

  2. With a physical examination: The doctor will check for blockage, swelling or drainage in the nose, ears and throat

  3. Conducting Blood tests

  4. Taking cultures from the nose

  5. Using imaging tests such as sinus x-rays or sinus computed tomography (CT scan): When basic treatments and medicines do not treat the condition, imaging tests are recommended to look for structural problems in the nose.

Treatment

The doctor may recommend an appropriate treatment plan, depending on the cause and severity of sinusitis. Some of the common treatment options for sinusitis include:


  1. Nasal irrigation: It helps to loosen the mucus and flush out the sinus. The device used for nasal irrigation has a long spout that helps to irrigate the nose. A sterile saline solution should be used for nasal irrigation.

  2. Nasal spray: This is another treatment option to clear out the sinuses and provide relief from nasal congestion.

  3. Decongestant medicines: These medicines are usually prescribed only for short-term use to provide relief from sinus pressure or pain. Over-the-counter decongestant medicines should be used only after consultation with the doctor as some medicines can even worsen the condition. Nasal decongestant sprays should not be used for more than three days as they can increase the swelling in the sinuses.

  4. Antibiotics: Antibiotics are prescribed when sinusitis is caused due to bacterial infection. The medicines are usually directed to be taken for 5-10 days. However, people usually start experiencing relief from the symptoms during the early days of treatment.

  5. Allergy medicines: These medicines are prescribed when the doctor suspects sinusitis caused due to allergic reactions.

  6. Steroids: Nasal steroids help to provide relief from swelling in the sinuses. Oral steroids are prescribed only in cases of chronic sinusitis. Steroids are associated with serious side effects. Hence, oral steroids are prescribed only when other medicines have proved to be ineffective.

  7. Surgery: Sinus surgery is recommended when all the medicines and other treatment options have failed. The types of surgeries that may be recommended to treat sinusitis include:

    1. Functional endoscopic sinus surgery: In this surgery, a special tube is passed through the nose to enlarge the channels that lead to the sinuses.

    2. Balloon sinuplasty: In this procedure, a balloon is inflated in the channels that lead to the nose. Subsequently, the balloon is inflated to widen the passageway and then deflated to remove the balloon.




The doctor may prescribe the following treatment plan, depending on the severity of the condition:

  1. People with simple sinusitis caused due to infection:

    1. Drinking fluids

    2. Over-the-counter allergy and cold medicines

    3. Decongestants

    4. Nasal saline irrigation



  2. People with symptoms that persist for more than ten days:





    1. Antibiotics

    2. Prescription steroid sprays for intranasal use

    3. Decongestants to be taken orally or to be applied to the skin





  1. People with chronic sinusitis:

    1. Prescription steroid sprays for intranasal use

    2. Saline solutions or other types of medicines (to rinse the nose)

    3. Antihistamines to be taken orally or to be applied on the skin

    4. Leukotriene antagonists (to provide relief from swelling and symptoms of allergy)




People can employ some of the following home remedies to improve drainage from the nose and sinuses:

  1. Keep the head at an elevated position while sleeping. People with pain on one side of the head should sleep on the pain-free side of the head.

  2. Inhale steam at least three to four times every day.

  3. Apply a warm compress on the face. It may help provide relief from sinus pain.

  4. Avoid drinking alcohol as it can worsen the swelling in the sinuses.

Lifestyle/management

People with sinusitis can make the following changes in their lifestyle to reduce the risk of recurrences of symptoms:


  1. Smokers should stop smoking or join a program that helps quit smoking.

  2. People with indoor allergies should regularly take medicines and avoid allergens such as dust mites, animal dander, etc.

  3. Drink lot of fluids to improve hydration and loosen the mucus.

Prognosis And Complications

Prognosis

People with acute sinusitis often find relief with simple treatment options. The availability of imaging tests and surgery has made it possible to treat complicated forms of acute and chronic sinusitis.

Complications

People with recurrent and chronic sinusitis are at an increased risk of complications, especially when the bacteria or viruses that cause the infection spread to nearby tissues and fluids. Some of the complications associated with sinusitis include:


  1. Temporary deafness

  2. Middle ear infection

  3. Severe headache

  4. Impaired vision

  5. Stiff neck

  6. Mental confusion

  7. Swelling of the forehead, cheeks or roof of the mouth

  8. Difficulty swallowing, breathing or speaking

  9. Meninges: This is a life-threatening complication wherein the tissue covering the brain and the spinal cord get infected.


People with a weakened immune system should undergo regular health check-ups to avoid complications.

Alternative Treatments

Some of the alternative treatment options that may provide relief from the symptoms of sinusitis include:


  1. Facial massage

  2. Acupuncture: This is an ancient practice wherein thin, metallic needles are used to penetrate into the skin and are activated by the practitioner using specific hand movements or electric stimulation.

  3. Acupressure: In this treatment, the practitioner uses his/her fingers to press certain acupuncture points in the body.

References


  1. Sinusitis [Updated Jun, 2011]. BetterHealth Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sinusitis#:~:text=Sinusitis%20means%20infection%20or%20inflammation,nose%2C%20facial%20pain%20and%20headache. Accessed on: Mar 2, 2021.

  2. Sinusitis [Updated Oct 6, 2020]. familydoctor.org. Available at: https://familydoctor.org/condition/sinusitis/. Accessed on: Mar 2, 2021.

  3. Sinus infection (sinusitis) [Updated Jun 4, 2020]. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/17701-sinusitis. Accessed on: Mar 2, 2021.

  4. Sinusitis (sinus infection or sinus inflammation) [Updated Oct, 2015]. Asthma and Allergy Foundation of America. Available at: https://www.aafa.org/sinusitis-sinus-infection/. Accessed on: Mar 2, 2021.

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