Sinusitis - Definition, Symptoms, Causes, Complications and Treatment

Sinusitis

Sinusitis or rhinosinusitis is defined as an inflammation of the mucous membrane that lines the paranasal sinuses. It can be due to upper respiratory viral infection, allergy, nasal polyps, deviated septum or autoimmune disases. Most sinusitis cases are due to a viral infection and resolve over the course of 10 days. Normally, sinuses are filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.

Classification of sinusitis including:

- Acute sinusitis: Symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses. A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 10 to 14 days.

- Subacute sinusitis: An inflammation lasting 4 to 12 weeks and represents a transition between acute and chronic infection.

- Chronic sinusitis: Swelling and inflammation of the sinuses are present for longer than 12 weeks. It may be caused by bacteria or a fungus.

- Recurrent sinusitis: Several attacks within a year (four or more acute sinusitis episodes that occur within one year). 

    

Acute Sinusitis

Acute Sinusitis



Acute sinusitis is defined as inflammation of the mucous membrane of a sinus, especially of the paranasal sinuses  for 4 weeks or less. It usually goes away without treatment. There are various treatments that may help to ease symptoms. Antibiotics are only sometimes needed.

A simple examination of the nose or endoscopic examination is usually sufficient for diagnosis.

New American Academy of Pediatrics (AAP) guidelines for acute bacterial sinusitis published online June 24 in Pediatrics. Changes include:

- Previous diagnostic criteria for acute bacterial sinusitis in children were acute upper respiratory tract infection (URI) with either nasal discharge and/or daytime cough for longer than 10 days or severe onset of fever, purulent nasal discharge, and other respiratory symptoms for 3 or more consecutive days. A third criterion added to the updated guideline is URI with worsening symptoms such as nasal discharge, cough, and fever after initial improvement.

- Physicians may now observe children with persistent infection lasting longer than 10 days for an additional 3 days before prescribing antibiotics, but antibiotics should still be given to children with severe onset or worsening symptoms.

- First-line therapy is amoxicillin with or without clavulanate.

- Imaging tests are not recommended for children with uncomplicated acute bacterial sinusitis, although children with suspected orbital or CNS complications should undergo CT scanning of the paranasal sinuses.

Chronic Sinusitis

Chronic Sinusitis

Chronic sinusitis can cause persistent sinusitis symptoms (nasal congestion, facial pain, headache, night-time coughing ...) lasts longer than three months and it can be caused by different diseases that share chronic inflammation of the sinuses as a common symptom. When nasal polyps are present, the condition is called chronic hyperplastic sinusitis. Chronic rhinosinusitis always associated with impaired sinus drainage and secondary bacterial infections.

Causes of Chronic Sinusitis

The presence of the following diseases and conditions can cause chronic sinusitis:

- Nasal polyps, tumor and other space-occupying lesions in the nose

- Allergic reactions

- Nasal septum deviation

- Facial trauma (Broken facial bone may cause blockage of sinus passages)

Other medical conditions:

- Cystic fibrosis

- Gastroesophageal reflux

- HIV and other immune system related diseases

- Respiratory infections. (These infections can be viral, bacterial or fungal in nature.)

- Allergic diseases such as hay fever.

Signs and Symptoms of Sinusitis

Signs and Symptoms of Sinusitis

Facial pain and pressure in the face along with a stuffy or runny nose are the main symptoms of sinusitis.

The location of pain and tenderness may depend on which sinus is affected.

Other common symptoms of sinusitis include:

- Headache

- Bad breath (halitosis)

- Yellow or greenish discharge from the nose or down the back of the throat

- Stuffy nose

- Cough that produces mucus

- Fever

- Tooth pain

- Reduced sense of taste or smell

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. At least two of the following signs and symptoms must be present for a diagnosis of chronic sinusitis:

- Drainage of a thick

- Yellow or greenish discharge from the nose or down the back of the throat

- Nasal obstruction or congestion

- Pain, tenderness and swelling around eyes, cheeks, nose or forehead

- Reduced sense of smell and taste

 Causes of Sinusitis

Sinusitis Causes

Factors which can cause to developing sinusitis include:

- Upper respiratory viral infections: The most common viral infections that lead to sinusitis are cold and flu infections. These viruses can spread to the sinuses from the upper airways. If a secondary bacterial infection develops, thick yellow or green mucus will be produced and sinuses will become inflamed and swollen.

- Allergies such as allergic rhinitis, asthma and hayfever

- Structural abnormalities, such as a deviated septum, small sinus ostia or a concha bullosa; nasal polyps

- Genetic causes such as carrying the cystic fibrosis gene (thick, sticky mucus builds up within the body, increasing the risk of infection)

- Both smoking and second hand smoke are associated with chronic rhinosinusitis

- Irritants: air pollution, smoke and chemicals, such as pesticides, disinfectants and household detergents

Diagnosis of Sinusitis

Sinusitis Diagnosis

Acute sinusitis can be diagnosed with patient's symptoms and endoscopic examination of the nose.

However more detailed examination of patient and several other methods may be require for chronic sinusitis diagnosis such as:

- Nasal endoscopy (This also is known as rhinoscopy). A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.

- Imaging studies. Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that's difficult to detect using an endoscope.

- Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as bacteria or fungi.

- Allergy tests. A skin test is safe and quick and can help pinpoint the allergen that's responsible for nasal flare-ups.

Complications of Sinusitis

Complications of Sinusitis

Complications of sinusitis include acute and chronic sequelae. Acute distant effects include toxic shock syndrome. Acute local effects can also occur. Acute orbital complications include the following: cellulitis, proptosis, chemosis, ophthalmoplegia, orbital cellulitis, subperiosteal abscess, and orbital abscess. Other acute complications include intracranial sequelae such as meningitis; encephalitis; cavernous or sagittal sinus thrombosis; or extradural, subdural, or intracerebral abscesses.

Bony complications include dental involvement and osteitis or osteomyelitis. Potts puffy tumor refers to swelling of the scalp, caused by an underlying osteitis of the skull or extradural abscess.

Chronic sinusitis complications include:

- Asthma flare-ups. Chronic sinusitis can trigger an asthma attack.

- Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.

- Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

- Aneurysms or blood clots. Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain and putting you at risk of a stroke.

Treatment of Sinusitis

Treatment of Sinusitis

Treatment of sinusitis include conservative preautions, medical treatment surgical treatment.

Conservative treatment methods include nasal irrigation,  applying a warm, moist cloth, drinking sufficient fluids and inhaling low temperature steam two to four times a day.

Medical treatment include antibiotic, decongestant, analgesic and corticosteroid treatmens.

Surgical treatment procedures perform for especially chronic or recurring sinusitis. A number of surgical approaches can be used to access the sinuses and these have generally shifted from external / extranasal approaches to intranasal endoscopic ones. The benefit of Functional Endoscopic Sinus Surgery (FESS) is its ability to allow for a more targeted approach to the affected sinuses, reducing tissue disruption, and minimizing post-operative complications.

Simple Suggestions That Can Be Done At Home For Sinusitis Treatment Applied by Our Grandparents!

Regarding the treatment of sinusitis, you can consider the following recommendations that you can apply at home, perhaps with regard to hot application and intranasal saline irrigation, which has been applied for many years. You can apply hot steam for 5-10 minutes by leaning over the container filled with hot water, putting the following herbs into the container, pulling a towel over your head:

- menthol and eucalyptus solutions (such as Vicks VapoRub or Buguseptil Solution sold in pharmacies)

- mint (dry or green fresh mint can be used)

- daisy

It is ideal for patients who are allergic to the plants listed here not to use these plants in steam application.

Applying hot steam to the face may be beneficial in the discharge of sinus secretions and in reducing pain, in addition to its antiviral and anti-inflammatory properties. Especially in patients with acute sinusitis attack, when there is facial pain and inflammatory nasal discharge, this application should be done 3 times a day and then irrigation of the nose with salt water (ocean water spray, sinus rinse, neti pot can be used). There are many beneficial effects of applying hot steam to the face, which has been known in Anatolia for a long time.

Apart from these applications, it is also beneficial to consume herbal teas orally and to increase the sleep time.

You can find more detail about endoscopic sinus surgery at >> www.ent-istanbul.com/2018/04/endoscopic-sinus-surgery.html

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52

E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199

Fax: +90 212 542 74 47