What is Sinusitis?

sinusitisSinusitis is an infection of the paranasal sinuses in which the mucous of the sinuses (sinus) becomes inflamed. This frequent inflammation may be acute or chronic. In most cases, the cause of the inflammation is virus or bacteria. Sinusitis may be associated with hereditary factors.

Sinusitis may arise in isolation or be associated with signs and symptoms of a general respiratory disease. The typical symptoms of sinusitis are headache and facial pain, as well as a greenish-yellow nasal discharge. Diagnosis can be easily made based on these discomforts. A physical examination and complementary tests such as X-ray images help complete the diagnosis.

To determine the extent of sinusitis and the accompanying symptoms, it is convenient to have additional tests.

Treatment for sinusitis is based on pharmacological treatment and on follow-up of general measures. If sinusitis is recurrent, surgical intervention may be necessary. The prognosis and evolution of sinusitis is usually favorable but can sometimes trigger serious complications such as meningitis or an abscess.

In case of inflammation of the nasal sinus mucosa, an infection of the sinuses may be added:

  • Maxillary sinusitis affects the maxillary sinus
  • Frontal sinusitis affects the frontal sinus
  • Sphenoid sinusitis affects the sphenoid bone
  • Ethmoidal sinusitis affects the ethmoid bone
  • If inflammation of the sinuses affect several breasts, or all at the same time, it is called polysinusitis or pansinusitis

Incidence of Sinusitis

Sinusitis is a very common pathology. Depending on the age, there are different types. In children, acute sinusitis is more frequent in the ethmoid bone and in adults, the maxillary sinus, ethmoid, frontal sinus and sphenoid are affected (according to frequency in descending order). Chronic sinus infection occurs most often in the maxillary sinus and ethmoid.


What are the causes of sinusitis?

Acute sinusitis

Acute sinusitis usually occurs after a cold or pharyngitis. In these cases, viruses are the most common cause. The affected mucous membrane becomes inflamed and can lead to a displacement of the sinus entry. As a result, as the mucosa has been weakened by viral inflammation, a secondary bacterial infection may be added. The triggering bacteria are mainly the bacteria Haemophilus influenzae, pneumococcus (Streptococcus pneumoniae) and streptococci.

what causes to sinusitis

Although a nasal inflammation is almost always caused by an inflammation of the paranasal sinuses, it is not always shown as a typical inflammation of the paranasal sinuses with corresponding symptoms. The degree to which acute sinusitis manifests itself depend on  several factors. Different dental pathologies such as infection of a dental root or trauma after extraction of a tooth may be responsible for a connection between the cavity of the maxillary sinus and the oral cavity and lead to an acute sinusitis affecting the maxillary sinus. Other special forms of acute sinusitis are the so-called bath sinusitis, caused by pathogens that are found in the water and penetrate during the bath in the nose. Barosinusitis is caused by pressure fluctuations in flight or diving.

Chronic sinusitis

Chronic sinusitis is caused by a narrowing at the entrance to the sinuses that prevents proper ventilation. The causes may be different factors such as the following:

  • Anatomical features (deviated nasal septum, enlarged turbinates, nasal polyps)
  • Weakened immune system and aggressive pathogens

Due to these unfavorable factors the correct drainage of the nasal mucus is persistently altered. This is the reason why initially a recurrent infection occurs in the paranasal sinuses that can evolve into chronic sinusitis.


What are the symptoms of sinusitis?

Chronic sinusitis is caused by a narrowing at the entrance to the sinuses that prevents proper ventilation. The causes may be different factors such as the following:

  • Anatomical features (deviated nasal septum, enlarged turbinates, nasal polyps)
  • Weakened immune system and aggressive pathogens

Due to these unfavorable factors the correct drainage of the nasal mucus is persistently altered. This is the reason why initially a recurrent infection occurs in the paranasal sinuses that can evolve into chronic sinusitis.

Sinusitis symptoms

Acute sinusitis usually begins with a persistent cold for several days. The most characteristic symptoms are inflamed sinuses and congestion in the facial area corresponding to the affected sinus. The pain increases with an infection of the sinuses, or when the patient bends quickly forward, standing or jumping with one leg. The pain is prickling, penetrating or pulsating and oppressive, especially in the affected sinus. The affected areas are stimulated by external shocks and pressures.

The nasal secretion in a sinusitis is usually purulent, greenish yellow and prolonged in time. The area of the nose and throat is usually affected. Nasal breathing is hampered by mucosal inflammation and secretion, patients can not smell good or feel the taste of food properly. An acute infection of the sinuses can also be expressed by general symptoms such as fever.

In addition to these major symptoms, an acute sinus infection can cause secondary symptoms such as headache, malaise, toothache, cough or reactive earaches.


How is sinusitis diagnosed?

The diagnosis of a sinusitis is done if people have the following symptoms: pain in the forehead or upper jaw region, nasal congestion, purulent rhinitis or smell disorders. In the physical examination of the acute inflammation of the paranasal sinuses, the typical symptoms of pain appear. Suspicion of sinusitis is assumed if pain occurs, for example, by rapidly flexing the head or pressure at certain points on the nerve terminals of the face.

To confirm the diagnosis of sinusitis, it is necessary to perform a diagnostic test in which an endoscope is inserted through the nose to visualize the nasal secretions. With the endoscopy, we can evaluate the anatomical changes of the nasal cavity. If secretion is necessary, the physician may take microbiological samples (for example, by puncturing the maxillary sinus) and directly demonstrate the existence of pathogens. In this way, it is possible to establish a specific treatment.

X-rays are useful for diagnosis, especially in acute sinusitis, since they can make visible a secretion or inflammation of the sinus mucosa.

To facilitate the assessment of anatomical changes, and to determine the extent to which the infection is spread. A CT scan can be done, which is also used for the diagnosis of chronic sinusitis. This is especially necessary before planning the surgery. Blood tests, allergy tests, olfactory tests and dental checks are also helpful in certain cases.


How is sinusitis treated?

For the treatment of sinusitis, conservative and surgical measures should be considered. Acute sinusitis can usually be resolved with conservative measures, while chronic sinusitis can only be cured with surgery.

Conservative treatment

If the doctor makes a diagnosis of sinusitis, the most appropriate treatment are decongestant drops (eg, corticosteroid preparations) and antibiotics. In the treatment of sinus infection, anti-inflammatories and antipyretic medicines are also used if necessary. Pain can be relieved by medications such as paracetamol, diclofenac or ibuprofen. In addition, in case of sinusitis it is always necessary to administer an antibiotic. Conservative treatment of sinusitis includes acupuncture and homeopathic medicines.

Acute discomfort from inflammation of the sinuses can be alleviated by draining the maxillary or frontal sinuses with rinses performed by the physician. This therapeutic alternative is not very frequent. Antibiotic treatment is often very effective and alternative treatments are not usually prescribed. These rinses are usually very annoying to the patient although they provide quick relief.

If there is chronic inflammation of the sinuses (sinusitis) as a consequence of an allergy, conservative therapy may consist of anti-inflammatory and mucolytic sprays. It is often advisable to do a desensitization or change the diet, for example, when there is intolerance to certain foods.

Surgery

If sinusitis is not resolved with other treatments, there is the option of intervening surgically. Usually, a chronic infection of the sinuses can only be resolved with surgery. Complications developed from sinusitis also often require surgical intervention.


Sinusitis Process

A properly and timely treated sinus infection (sinusitis) usually develops favorably and has a good prognosis. If a scar is formed after a chronic sinusitis infection, or chronic inflammation caused by the surgical removal of the polyps, a second surgical operation is sometimes necessary.

Sinusitis complications

Complications of sinusitis are rare, but may have a very dangerous course and in some cases lead to permanent damage. Therefore, it is important to detect them in time to avoid them.

If inflammatory or anatomical narrowing can not be permanently removed, infection of the sinusitis can be expected to continue and to recur. If chronic sinusitis is present, acute relapses are always possible. This can lead to complications such as throat inflammation, laryngitis and acute bronchitis. In this case we have the so-called sinobronchial syndrome.

Without adequate treatment with sinusitis can develop more serious complications: in the later course of inflammation, the anatomical structures close to the affected sinuses may also be affected. Thus, for example, in inflammation of the frontal sinuses, the skin of the forehead and upper eyelid are swollen and red. In the infection of the maxillary sinuses, there is mainly a swelling in the cheek and lower eyelid. An inflammation of the eye cavity can cause a swelling of the eyelids, vision disorders and even loss of vision and limited mobility of the eyes.

If inflammation of the paranasal sinuses progresses in the direction of the brain, it can cause meningitis with typical neck pain (torticollis), and accumulation of pus in the structures of the brain (brain abscess). In extreme cases, there are neurological disorders with complications such as seizures or paralysis of the cranial nerves or cranial nerves. It is also possible that a blood clot forms in the vessels of the brain (cavernous sinus thrombosis), and a soft tissue or bone infection (osteomyelitis).

How to prevent sinusitis?

Usually, sinusitis develops from a cold or an inflammation of the throat. For this reason, it is recommended to follow a healthy life and to prevent colds following general measures like the following ones:

  • Drink plenty of fluids.
  • Rinse the nose three or four times a day with a saline solution
  • Make steam baths
  • Ensure a humid environment
  • Nasal irrigation (nasal shower)

Nasal irrigation or nasal shower with a saline solution is very beneficial to prevent sinusitis. This measure is useful to prevent infection and to treat acute virus infections because it entrains the nasal mucus. Currently, specific preparations for nasal lavage are available on the market. Alternatively, there is the option to prepare them at home. To do this, pour one tablespoon of common salt (about nine grams) in a liter of warm water. In case of cold rinse, three or four times is enough for prevention. The salt solution cleanses the nose. Finally, after the resolution of the picture, the mucous membranes recover.

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