Sinusitis - Symptoms, Causes, Prevention, Treatment

sinusitis

Sinusitis is the inflammation and swelling of the lining of the sinuses adjacent to the nose. Sinusitis is caused when these sinuses become infected. Sinuses are four cavities (spaces) located in the head. Narrow channels connect them. The sinuses produce thin mucus that drains from the nose. It keeps the nose clean and bacteria-free. Our sinuses are generally filled with air. However, they can get filled with fluid and can get blocked. It results in the growth of bacteria, which causes an infection.

An infection of the sinuses is often confused with rhinitis, a medical term for inflammation (swelling) and irritation of the nasal passages. Rhinitis, however, only affects the nasal passages. It might be caused by allergies or a cold.

Sinusitis can be of four types, i.e., Acute, chronic, subacute, and recurrent acute sinusitis.

Acute sinusitis: In an acute sinus infection, the symptoms are present for less than four weeks.

Chronic sinusitis: Chronic sinusitis is when the sinusitis symptoms persist for 12 weeks or more.

Subacute sinusitis: When sinusitis symptoms last for four to 12 weeks, it is termed as subacute sinusitis.[3]

Recurrent sinusitis: In recurrent sinusitis, you may keep getting sinus infection symptoms four or more than four times in a year, which last less than two weeks each time.

Causes

1. A virus, bacteria, or fungus can infect the sinuses and cause them to swell, leading to sinusitis.However, in most cases of sinusitis, a viral upper respiratory tract infection is the trigger, with bacterial sinusitis constituting just two per cent of cases.
2. The other causes of sinusitis include:
3. Allergic and nonallergic rhinitis.
4. Immotile cilia syndrome (a syndrome in which the smaller hair in the nose and the body, called cilia, do not move independently).
5. Enlarged adenoids (a piece of tissue just behind the nose and high up in the throat).
6. Neoplasia (abnormal, uncontrolled growth of cells in the body).

Signs & Symptoms 

Sinusitis may have different symptoms depending on your age. Common signs and symptoms of sinusitis in younger children include:

1. Runny nose and symptoms of a cold, which last for a long time. It can be around seven to 10 days. There is often a thick green or yellow discharge, but it can also be clear.
2. Occasional coughing in the daytime
3. Swelling near the eyes
4. Cough at night.
5. Common signs and symptoms of sinusitis in older children and adults include:
6. Postnasal drip (a drip of mucus down the throat from the nose)
7. Thick yellow or green discharge from nose and nose blockage.
8. Ear pain or toothache
9. Halitosis (bad breath).
10. Cough.
11. Facial pressure (especially around the nose, forehead, and eyes)
12. Tiredness.

Diagnosis 

When you visit your ENT specialist, they will ask several questions to develop a complete medical history and learn about your symptoms. The ENT specialist will then conduct a physical examination and suggest laboratory and imaging tests.

Physical examination: 

1. During the physical exam, your ENT specialist will look for any swelling, blockage or drainage in your ears, nose, and throat.
2. Your ENT specialist may use a thin, illuminated video camera (nasal endoscope) that is passed through the nostril hole. The endoscope allows the ENT specialist to view the nose and sinuses, thereby identifying polyps (a small growth protruding from a mucous membrane) or swelling.
3. Laboratory tests: Laboratory tests might provide extra diagnostic information in acute or chronic sinusitis patients. The results of these tests might suggest the presence of an underlying disease. 
4. Nasal cytology (study of the fluid from the nasal mucosa)
5. Nasal-sinus biopsy (removing a small amount of tissue to examine under a microscope)

Tests for immunodeficiency.

Imaging studies: When symptoms are ambiguous, physical test results are unclear, or clinical disease continues despite effective medical therapy, imaging tools can give confirming evidence. These studies include:

Ultrasonography: This procedure has lesser use but can be used in pregnant women to determine the amount of sinus secretions that are retained. 

Radiographs: While standard radiographs may be used to identify acute sinusitis, they are not so sensitive. 

Magnetic resonance imaging (MRI): It is a sensitive approach for detecting suspected fungal sinusitis and distinguishing between inflammation and malignant (cancerous) tumours.

To diagnose chronic sinusitis fully, your ENT specialist would also need to see polyps, pus, or thickened mucus in the nose or recommend a computed tomography (CT) scan.

Diagnostic procedure

Rhino laryngoscopy: It provides a direct view of abnormalities of the septum (cartilage in the nose that separates the nostrils), turbinates (tissue within the nasal passageways), and nasopharynx (a part of the pharynx behind the nose). This procedure also helps to view the posterior tongue, epiglottis (a lid just above the pharynx), glottis (a part of the larynx), and vocal cords.[11]

Treatment

Your ENT specialist will decide the best treatment option for sinusitis depending on your medical history, age, infection intensity, and preference.[1] Here are the common treatment options available for sinusitis:

Home remedies: 

1. The following are examples of home remedies:
2. Start using humidification/vaporiser (it induces moisture in the air and prevents the air from drying our eyes, nose and throat).
3. Adequate hydration (drink at least eight glasses of water every day).

Stop smoking

1. Balanced nutrition
2. Warm compresses: Dip a towel in lukewarm water and squeeze the water out of the towel. Wrap the towel and put it over your nose and forehead. This method will give you relief from the inflammation in the nostrils.

Lifestyle changes:

1. Drink extra fluids, which help to thin nasal secretions.
2. Avoid triggers such as animal dander and dust mites if you have indoor allergies (if you sneeze, your nose gets congested, or you get itchy eyes, all from the comfort of your home, you may have an indoor allergy).

Medication:

1. Symptoms can be relieved by:
2. Topical decongestants (medicines that provide relief from the stuffy nose)
3. Mucolytics (medications used to treat mucus hypersecretion)
4. Topical steroids (to reduce inflammation)
5. Topical cromolyn (to treat allergies)
6. Non-narcotic analgesics (these painkillers help to relieve the pain)
7. Antimicrobial therapy is the cornerstone of sinusitis treatment, and it depends on the type of sinusitis you have. Examples of antibiotics include penicillins, cephalosporins, and macrolides.

1)Sinusitis can lead to bacterial infections, due to a non-trivial amount of bacteria being trapped in your sinuses. Sometimes the effects of sinusitis can be greatly reduced by decongestant nasal drops that soothe mucous membranes and reduce swelling. This will help you to breathe more clearly through your nose.

2) Sinusitis treatment can help one get relieved from pain, headache

Risks associated with delayed treatment

Delaying of sinusitis treatment can lead to severe outcomes such as:

1. Neurological complications, such as altered mental status, nuchal rigidity (neck stiffness), and papilloedema (optic nerve swelling)
2. There can also be seizures, hemiparesis (partial paralysis on one side of the body), or other neurological deficits found in the late stages of the disorder.
3. Brain abscess (a swelling in your brain filled with pus)
4. Epidural abscess (an infection that forms in the space between your skull bones and your brain lining)
5. Cerebral venous sinus thrombosis (CVST). It is characterised by the formation of clots in the brain's venous sinuses.