Sinusitis

Sinusitis refers to an inflammation of the sinuses, airspaces within the bones of the face. Sinusitis is most often due to an infection within these spaces.

Description

The sinuses are paired air pockets located within the bones of the face. They are:

• the frontal sinuses; located above the eyes, in the center region of each eyebrow
• the maxillary sinuses; located within the cheekbones, just to either side of the nose
• the ethmoid sinuses; located between the eyes, just behind the bridge of the nose
• the sphenoid sinuses; located just behind the ethmoid sinuses, and behind the eyes

The sinuses are connected with the nose. They are lined with the same kind of skin found elsewhere within the respiratory tract. This skin has tiny little hairs projecting from it, called cilia. The cilia beat constantly, to help move the mucus produced in the sinuses into the respiratory tract. The beating cilia sweeping the mucus along the respiratory tract helps to clear the respiratory tract of any debris, or any organisms which may be present. When the lining of the sinuses is at all swollen, the swelling interferes with the normal flow of mucus. Trapped mucus can then fill the sinuses, causing an uncomfortable sensation of pressure and providing an excellent environment for the growth of infection-causing bacteria.

Causes and symptoms

Sinusitis is almost always due to an infection, although swelling from allergies can mimic the symptoms of pressure, pain, and congestion; and allergies can set the stage for a bacterial infection. Bacteria are the most common cause of sinus infection. Streptococcus pneumoniae causes about 33% of all cases, while Haemophilus influenzae causes about 25% of all cases. Sinusitis in children may be caused by Moraxella catarrhalis (20%). In people with weakened immune systems (including patients with diabetes; acquired immunodeficiency syndrome or AIDS; and patients who are taking medications which lower their immune resistance, such as cancer and transplant patients), sinusitis may be caused by fungi such as Aspergillus, Candida, or Mucorales.

Acute sinusitis usually follows some type of upper respiratory tract infection or cold. Instead of ending, the cold seems to linger on, with constant or even worsening congestion. Drainage from the nose often changes from a clear color to a thicker, yellowish-green. There may be fever. Headache and pain over the affected sinuses may occur, as well as a feeling of pressure which may worsen when the patient bends over. There may be pain in the jaw or teeth. Some children, in particular, get upset stomachs from the infected drainage going down the back of their throats, and being swallowed into their stomachs. Some patients develop a cough.

Chronic sinusitis occurs when the problem has existed for at least three months. There is rarely a fever with chronic sinusitis. Sinus pain and pressure is frequent, as is nasal congestion. Because of the nature of the swelling in the sinuses, they may not be able to drain out the nose. Drainage, therefore, drips constantly down the back of the throat, resulting in a continuously sore throat and bad breath.

Diagnosis

Diagnosis is sometimes tricky, because the symptoms so often resemble those of an uncomplicated cold. However, sinusitis should be strongly suspected when a cold lingers beyond about a week's time.

Medical practitioners have differing levels of trust of certain basic examinations commonly conducted in the office. For example, tapping over the sinuses may cause pain in patients with sinusitis, but it may not. A procedure called "sinus transillumination" may, or may not, also be helpful. Using a flashlight pressed up against the skin of the cheek, the practitioner will look in the patient's open mouth. When the sinuses are full of air (under normal conditions), the light will project through the sinus, and will be visible on the roof of the mouth as a lit-up, reddened area. When the sinuses are full of mucus, the light will be stopped. While this simple test can be helpful, it is certainly not a perfect way to diagnose or rule out the diagnosis of sinusitis.

X-ray pictures and CT scans of the sinuses are helpful for both acute and chronic sinusitis. People with chronic sinusitis should also be checked for allergies; and they may need a procedure with a scope to see if any kind of anatomic obstruction is causing their illness. For example, the septum (the cartilage which separates the two nasal cavities from each other) may be slightly displaced, called a deviated septum. This can result in chronic obstruction, setting the person up for the development of an infection.

Treatment

Antibiotic medications are used to treat acute sinusitis. Suitable antibiotics include sulfa drugs, amoxicillin, and a variety of cephalosporins. These medications are usually given for about two weeks, but may be given for even longer periods of time. Decongestants, or the short-term use of decongestant nose sprays, can be useful. Acetaminophen and ibuprofen can decrease the pain and headache associated with sinusitis. Also, running a humidifier can prevent mucus within the nasal passages from drying out uncomfortably, and can help soothe any accompanying sore throat or cough.

Chronic sinusitis is often treated initially with antibiotics. Steroid nasal sprays may be used to decrease swelling in the nasal passages. If an anatomic reason is found for chronic sinusitis, it may need to be corrected with surgery. If a surgical procedure is necessary, samples are usually taken at the same time to allow identification of any organisms present which may be causing infection.

Fungal sinusitis will require surgery to clean out the sinuses. Then, a relatively long course of a very strong antifungal medication called amphotericin B is given through a needle in the vein (intravenously).

Alternative treatment

Chronic sinusitis is often associated with food allergies. An elimination/challenge diet is recommended to

Sinusitis is the inflammation of the sinuses caused by a bacterial infection. Sometimes diagnosis may be problematic because the symptoms often mimic those of the common cold. Sinusitis is usually treated with antibiotics. (Illustration by Electronic Illustrators Group.)

identify and eliminate allergenic foods. Irrigating the sinuses with a salt water solution is often recommended for sinusitis and allergies, in order to clear the nasal passages of mucus. Another solution for nasal lavage (washing) utilizes powdered goldenseal (Hydrastis canadensis). Other herbal treatments, taken internally, include a mixture made of eyebright (Euphrasia officinalis), goldenseal, yarrow (Achillea millefolium), horseradish, and ephedra (Ephedra sinica), or, when infection is present, a mixture made of echinacea (Echinacea spp.), wild indigo, and poke root (Phytolacca decandra-Americana).

Homeopathic practitioners find a number of remedies useful for treating sinusitis. Among those they recommend are: Arsenicum album, Kalium bichromium, Nux vomica, Mercurius iodatus, and Silica.

Acupuncture has been used to treat sinusitis, as have a variety of dietary supplements, including vitamins A, C, and E, and the mineral zinc. Contrast hydrotherapy (hot and cold compresses, alternating 3 minutes hot, 30 seconds cold, repeated 3 times always ending with cold) applied directly over the sinuses can relieve pressure and enhance healing. A direct inhalation of essential oils (2 drops of oil to 2 cups of water) using thyme, rosemary, and lavender can help open the sinuses and kill bacteria that cause infection.

Prognosis

Prognosis for sinus infections is usually excellent, although some individuals may find that they are particularly prone to contracting such infections after a cold. Fungal sinusitis, however, has a relatively high death rate.

Prevention

Prevention involves the usual standards of good hygiene to cut down on the number of colds an individual catches. Avoiding exposure to cigarette smoke, identifying and treating allergies, and avoiding deep dives in swimming pools may help prevent sinus infections. During the winter, it is a good idea to use a humidifier. Dry nasal passages may crack, allowing bacteria to enter. When allergies are diagnosed, a number of nasal sprays are available to try to prevent inflammation within the nasal passageways, thus allowing the normal flow of mucus.