Sinusitis is an inflammation of the skin that lines paranasal sinuses. The paranasal sinuses are pairs of hollow cavities in the skull that are of varying shapes and sizes. They are located around the nose and communicate with the nose through tiny openings. There are four pairs of sinuses: Maxillary, ethmoid, frontal and sphenoid. They are lined by cells that bear fine, hairlike cilia and by mucus-secreting goblet cells. The cilia by beating in a wave-like motion propel the mucus towards the openings of sinuses and into the nasal cavity. Any interference with the beating of cilia will result in accumulation of mucus in the sinuses. The accumulated mucus gets secondarily infected with bacteria, and this leads to a sinus infection. When the process is less than three weeks in duration, it is known as acute sinusitis. Chronic sinusitis is more than six weeks in duration, and subacute sinusitis is between 3-6 weeks in length.

What causes sinus infections?

There are several conditions that predispose to the occurrence of sinusitis. They are

  • Infections by viruses, bacteria, molds and other organisms
  • Inflammation caused by allergies
  • Irritation by pollution, chemicals, smoke, etc.
  • Anatomical obstructions caused by nasal polyps, concha bullosa, nasal spurs and adenoids
  • Moreover, rare absence of cilia from birth, immunodeficiency caused by primary immunodeficiency diseases (genetic origin) and secondary immunodeficiency diseases like HIV

Acute Vs Chronic Sinusitis

Acute sinusitis is characterized by onset of any combination of the following symptoms: significant nasal congestion and stuffiness not relieved by usual allergy and decongestant medications, production of thick, copious and discolored nasal mucus, facial pain and pressure, tooth pain, bad breath, significant postnasal drainage, sore throat, cough, fever and a sense of not feeling well. It often starts as a cold. It does not get better within a week or so. Persistent cold symptoms lasting beyond 7-10 days could mean sinus infection.

Physical examination in the doctor’s office reveals congested, red and swollen nasal mucosal lining, bad breath, and drainage of pus from sinus openings, postnasal drainage and tenderness on palpation of the sinuses. In chronic sinusitis, many of the symptoms mentioned above and signs may be absent, and CT scan usually makes a diagnosis.

Diagnosing sinusitis

Diagnosis is often by clinical history and by examination. Sometimes your doctor may order CT scan of the paranasal sinuses for better understanding of the problem. X-rays are poor substitutes for diagnosing sinusitis and CT scans are preferred. The CT may show thickening of the mucus lining of the sinuses, presence of pus (air-fluid level), obstruction of sinus openings and other anatomical abnormalities mentioned above. In patients with chronic sinus infections, further studies to rule out cystic fibrosis, immotile cilia syndrome and immunodeficiency are in order.

Treatment of sinusitis

Treatment of acute sinus infections includes (with your doctor’s permission) regular irrigation with normal saline nasal wash, regular use of intranasal corticosteroid sprays such as Nasonex, Flonase, Rhinocort Aqua or Nasacort AQ, use of mucolytic agents such as Mucinex or guaifenesin and antibiotics for 14-21 days. Studies have shown that combined use of nasal sprays and antibiotics is more effective in treating acute sinus infections than either of them used alone. Antihistamines can interfere with regular beating of the cilia and make the mucus thicker; for these reasons, some physicians may stop antihistamines until recovery. Sinus cavities do not have a significant blood supply. Therefore, antibiotics are used for more than 14-21 days to allow better penetration into infected sinus cavities. Occasionally your doctor may use a short course of steroids or decongestant medications by mouth to relieve swelling in the nostrils, and this will facilitate better drainage of the sinuses.
Treatment of chronic sinusitis with antibiotics is controversial. Many physicians begin to look at chronic sinusitis as something to do with chronic inflammation rather than with infections. Therefore, your doctor is more likely to prescribe oral and inhaled steroid medications rather than give antibiotics to treat this condition. If there are mechanical problems in the nasal cavities or if medical management fails, your doctor may refer you to an ear, nose and throat specialist for surgical treatment. Patients with underlying conditions such as cystic fibrosis, immotile cilia syndrome, and immunodeficiency will benefit from treatment of those conditions.

How to prevent sinus infections

There are few measures if regularly implemented will reduce the frequency and severity of sinus infections significantly in allergy sufferers. They include regular use of normal saline nasal wash, taking allergy medications (especially prescription nasal sprays) regularly, staying away from allergens (grass, pets, mold, dust and dust mites) and irritants (smoke, chemicals and smog), regular hand washing, avoiding gathering of people during flu epidemics and taking influenza vaccination regularly. If indicated taking Pneumonia vaccine once may also help. Allergy injections if regularly taken by allergy sufferers will control the sinus infections much better.
Sinusitis is one of the common chronic illnesses having a significant impact on the physical and economic well-being of people. By understanding it better and by following some of the guidelines above, you will lead a much happier and healthier life.

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