Article 313. Sinusitis

Sinusitis

What is a sinus?

A sinus is a hollow, air-filled cavity. For the purposes of this article, a sinus will referred to those hollow cavities that are in the skull and connected to the nasal airway by a narrow hole in the bone (ostium). Normally all are open to the nasal airway through an ostium. Humans have four pair of these cavities each referred to as the:

·         frontal sinus (in forehead),

·         maxillary sinus (behind cheeks),

·         ethmoid sinus (between the eyes), and

·         sphenoid sinus (deep behind the ethmoids).

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. 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.

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in the lining of the nose), or a deviated septum (a shift in the nasal cavity).

There are different types of sinusitis, including:

 Acute sinusitis: 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. Acute sinusitis typically lasts 4 weeks or less.

Subacute sinusitis: An inflammation lasting 4 to 8 weeks.

Chronic sinusitis: A condition characterized by sinus inflammation symptoms lasting 8 weeks or longer.

Recurrent sinusitis: Several attacks within a year.

Who Gets Sinusitis?

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:

·         Nasal mucous membrane swelling as from a common cold

·         Blockage of drainage ducts

·         Structural differences that narrow the drainage ducts

·         Nasal polyps

·         Conditions that result in an increased risk of infection such as immune deficiencies or taking medications that suppress the immune system.

In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on one's back, and smoke in the environment.

In adults, the contributing factors are most frequently infections and smoking.

What Are the Signs and Symptoms of Acute Sinusitis? 

Some of the primary symptoms of acute sinusitis include:

·         Facial pain/pressure

·         Nasal stuffiness

·         Nasal discharge

·         Loss of smell

·         Cough/congestion

Additional symptoms may include:

·         Fever

·         Bad breath

·         Fatigue

·         Dental pain

Acute sinusitis may be diagnosed when a person has two or more symptoms and/or the presence of thick, green, or yellow nasal discharge.

How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will review your symptoms and give you a physical examination.

The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests to assess the potential causes for sinusitis may include a mucus culture, nasal endoscopy (see below), X-rays, allergy testing, CT scan of the sinuses, or blood work.

What Is Nasal Endoscopy?

 A nasal endoscope is a special tube-like instrument equipped with tiny lights and cameras used to examine the interior of the nose and sinus drainage areas.

A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. Your nasal cavity may first be numbed using a local anesthetic (some cases do not require any anesthetic). A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.

The procedure is used to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic exam, the doctor also looks for any structural abnormalities that would cause you to suffer from recurrent sinusitis.

How Is Sinusitis Treated?

Treatment for sinusitis depends on the severity.

 Acute sinusitis. If you have a simple sinus infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone. Use of nonprescription decongestant nasal drops or sprays may also be effective in controlling symptoms. However, these medicines should not be used beyond their recommended use, usually four to five days, or they may actually increase congestion. If antibiotics are given, they are usually given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required.

Chronic sinusitis. Warm moist air may alleviate sinus congestion. A vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of nonprescription decongestant nasal drops or sprays might be effective in controlling symptoms, however, they should not be used beyond their recommended use. Antibiotics or oral steroids may also be prescribed.

Other Treatment Options for Sinusitis

 Addressing potential triggers or contributing factors is a key first step in the management of sinusitis. To reduce congestion due to sinusitis, your doctor may prescribe nasal sprays (some may contain steroid sprays), nose drops, or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation -- usually only when other medications have not worked. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for a fungal sinus infection. Immunoglobulin (antibodies) may be given if you have certain immune deficiencies.

 Will I Need to Make Lifestyle Changes?

Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is Sinus Surgery Necessary? 

Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which can obstruct sinus drainage, surgery may be needed.

Surgery may be performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery. Full recovery usually takes about four to six weeks.

A procedure called a "turbinectomy" may also be performed to shrink the swollen tissues of the nose. This can be done in your doctor's office and can take only a few minutes. The anesthetic used is very similar to that used in routine dental procedures.

What Happens If Sinusitis Is Not Treated?

Delaying treatment for sinusitis may result in suffering from unnecessary pain and discomfort. In extremely rare circumstances, untreated sinusitis can lead to meningitis or brain abscess and infection of the bone.

Article # 312. Sinus

Sinus

The sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are around an inch across; others are much smaller. The sinus cavities include:

• The maxillary sinuses (the largest), in the cheekbones.
• The frontal sinuses, in the low-center of the forehead.
• The ethmoid sinuses, between the eyes, at the nasal bridge.
• The sphenoid sinuses, in bones behind the nasal cavity.

The sinuses are lined with soft, pink tissue called mucosa. Normally, the sinuses are empty except for a thin layer of mucus.

The inside of the nose has ridges called turbinates. Normally these structures help humidify and filter air. The nose is divided in the center by a thin wall, called the septum. Most of the sinuses drain into the nose through a small channel or drainage pathway called the middle meatus.

The purpose of the sinuses is unclear. One theory is that sinuses help humidify the air we breathe in; another is that they enhance our voices.

Sinus Conditions

Acute sinusitis (sinus infection): Viruses or bacteria infect the sinus cavity, causing inflammation. Increased mucus production, nasal congestion, discomfort in the cheeks, forehead or around the eyes and headaches are common symptoms.

Chronic sinusitis (or chronic rhinosinusitis): More than just a series of infections, chronic sinusitis is a persistent process of inflammation of the sinuses.

Allergic rhinitis: Allergens like pollen, dust mites, or pet dander cause the defenses in the nose and sinuses to overreact. Mucus, nasal stuffiness, sneezing, and itching result.

Deviated septum: If the septum that divides the nose deviates too far too one side, airflow can be obstructed.

Turbinate hypertophy: The ridges on the nasal septum are enlarged, potentially obstructing airflow.

Nasal polyps: Small growths called polyps sometimes grow in the nasal cavity, in response to inflammation. Asthma, chronic sinus infections, and allergic rhinitis can lead to nasal polyps.

 Sinus Tests

Physical examination: A doctor can look into the nose with a lighted viewer to see the turbinates, which may be swollen. She may press or tap on the face over the sinuses to check for pain.

Computed tomography (CT scan):  A CT scanner uses X-rays and a computer to create detailed images of the sinuses. CT scanning can help diagnose chronic sinusitis.

Magnetic resonance imaging (MRI): Magnetic waves create highly detailed images of the sinuses. CT and MRI scans may be used together.

Endoscopy (rhinoscopy): Using a flexible tube with a camera on its end, a doctor can examine the inside of the nose and sinuses.

Sinus cultures: A mucus sample can be taken from inside the sinuses. This is done with a needle or during endoscopy.

Skin Test for Allergies: Skin testing for various allergens can help determine if allergies are contributing to sinusitis.

Sinus X-ray: A plain X-ray may show problems with the bones around the sinuses. A CT scan is superior to plain X-ray films.

Sinus Treatments

Decongestants: Medications that cause blood vessels in the inner nasal tissue to constrict. As a result, there is less sinus congestion, mucus production and postnasal drip. 

Nasal steroid spray: Regular use of nasal steroids can reduce the symptoms of allergic rhinitis. These medications help relieve tissue swelling and help prevent the regrowth of nasal polyps after sinus surgery.

Nasal saline spray: Salt water nasal spray breaks up dried mucus and helps to keep the nose moist.

Nasal washes: rinse mucous from the nasal cavities and sinuses.

Antihistamines: Oral histamine blockers (Benadryl, Claritin, Zyrtec, Allegra) can reduce the nasal and sinus symptoms from allergic rhinitis.

Antibiotics: Anti-bacterial oral medicines may be needed to treat bacterial sinusitis.

Sinus surgery: Surgery can improve or correct some sinus conditions. Usually surgery is used to remove growths or to open an obstruction.