Sinusitis

When we have a stuffy nose, drainage, or pain behind the bones of the face, we often say we’re having “sinus problems”. What causes these uncomfortable symptoms, and why do some people seem to have them over and over again?

There are four pairs of sinuses, or hollow cavities located within the skull or bones of the head around the nose. Each of these sinuses is lined with mucous membrane, which is a thin layer of skin that secretes mucus. Each sinus has an opening into the nose which allows air to flow into the sinus and mucous to exit the sinus. Sinus problems occur when something causes swelling in the nose or in this mucous membrane lining the sinus cavities including an infection, an allergic reaction, or another type of immune reaction.

When the sinus tissue swells, air can be trapped in the sinus, along with mucus or pus. This can cause the sometimes intense pain of a sinus attack as pressure builds up inside the sinus cavity. This infection or inflammation of the sinuses is called sinusitis or Rhinosinusitis.

There are four basic types of sinusitis:

• Acute Sinusitis – cases lasting 4 weeks or less
• Subacute Sinusitis – cases lasting from 4 to 12 weeks
• Chronic Sinusitis – cases lasting more than 12 weeks and up to several months or even years
• Recurrent Sinusitis – acute attacks repeated several times during a year

Acute Sinusitis

Acute sinusitis is typically caused by an infection. Most cases are caused by the common cold, which is a viral infection that cannot be treated with antibiotics. But an upper respiratory tract infection that lasts for a week to 10 days is more likely to be caused by a bacterial infection, which can be treated with antibiotics. Some people, especially those with sinus abnormalities or those with a weakened immune system may also be at higher risk of fungal infections in the sinuses.

You may be at an increased risk of sinusitis if you are regularly exposed to pollutants like cigarette smoke. Certain health conditions can also increase your risk:

• Allergies – Fever and other types of allergies can cause inflammation that will block the sinuses and prevent proper drainage.
• Nasal polyps or tumors – tissue growths can block the nasal passages or sinuses.
• Deviated nasal septum – the wall between the nostrils is called the nasal septum. If this wall is crooked it can restrict or block the sinus passages.
• Tooth infection – in rare cases, acute sinusitis can be caused by an infected tooth.
• Enlarged or infected adenoids in children – the adenoids are groups of lymph tissue located on either side of the back part of the throat. Infections in the adenoids are more common in children.
• Other medical conditions – Complications from other conditions, including cystic fibrosis, Gastroesophageal reflux disease (GERD), or immune system disorders may cause blocked sinuses or an increased risk of infection.

Chronic Sinusitis

In chronic sinusitis, the membranes lining the sinus cavities and inside of the nose become thickened because they are constantly inflamed. This causes repeated or ongoing sinusitis that can last for months or years. This condition is more common in people with asthma, most of whom also have allergies. However, at least half of chronic sinusitis sufferers do not have allergies. While the causes of chronic sinusitis are mostly unknown, most health experts agree that chronic sinusitis is not an infectious disease, which means people with chronic sinusitis cannot pass it to other people as if it was a cold.

Treating Sinusitis

Treatment for acute sinusitis includes:

• Antibiotics – only helpful if the cause is a bacterial infection
• Pain relievers – to reduce the aching in the face caused by pressure in the sinuses
• Decongestants – to reduce the build-up of pressure and congestion in the sinuses
• Allergy treatments – nasal steroid sprays can reduce allergic swelling in the nasal passages and allow the sinuses to drain

Treating chronic sinusitis is more difficult. The two main forms of treatment are nasal steroid sprays and long courses of oral antibiotics.We also recommend using saline (salt water) washes in the nose to help remove thick mucus and allow the sinuses to drain. Some time we prescribe oral steroid, such as prednisone, to reduce swelling in the nasal passages. Oral steroids can have significant side effects and should be used with caution. Surgery is sometime indicated to treat chronic sinusitis to improve sinus drainage by enlarging the sinus openings and removing any obstructions including nasal polyps and a deviated septum.

Tips to Reduce Sinusitis

• Add moisture – keep the nose moist by using saline sprays and avoiding dry environments. A humidifier may help if you live in a dry climate.
• Avoid irritants – stay away from cigarette and cigar smoke, and strong chemical odours.
• Avoid allergens– if you are allergic to it, stay away. An allergy specialist can test to find out what you are allergic to.
• Avoid chlorine – long periods of swimming in pools treated with chlorine can irritate the lining of the nose and sinuses.
• Don’t dive – water diving forces water into the sinuses, which can irritate the lining of the sinus and carry bacteria into the sinus cavity.

Author Info

Dr Manish Goyal