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Sinusitis

 

What is sinusitis?

The sinuses are the air-filled cavities located behind your cheekbones and forehead. Sinusitis is the inflammation and swelling of the lining of the sinuses.

There are 4 types of sinusitis: acute, subacute, chronic and recurrent.

Acute sinusitis describes the sudden onset of cold like symptoms which include a stuffy nose and facial pain which usually last for no longer than a week, but can last up to 3 weeks

Subacute sinusitis defines an infection as lasting over 1 month but less than 3 months.

Chronic sinusitis, also known as chronic rhinosinusitis, describes the condition where symptoms last for more than 3 months.

Recurrent sinusitis is when a person experiences several attacks in one year.

What are the symptoms of sinusitis?

Symptoms of sinusitis include:-

  • Blocked nose
  • Pain, swelling and tenderness around cheeks, eyes or forehead
  • Green/yellow nasal discharge
  • High temperature
  • Headache in sinus region
  • Runny nose (usually clear or whitish in people with non-infectious sinusitis)
  • Cough
  • Ear pain or hearing problems
  • Lethargy
  • Reduced sense of taste and smell
  • Toothache
  • Bad breath

Symptoms of facial pain, pus like nasal discharge which last for longer than a week and are not responding to over-the-counter medications is most likely to be a bacterial sinus infection.

If you go on to develop any of the following symptoms seek urgent medical advice or help. They could indicate complications of a sinus infection which, although rare, could lead to far more serious infections such as meningitis, orbital cellulitis or brain abscess:

  • Difficulty breathing
  • Chest pain
  • Severe headache
  • Eyelids becoming discoloured, swollen or painful
  • Drowsiness/confusion
  • Persistent vomiting
  • Stiff neck
  • Rash which doesn’t fade under pressure

What causes sinusitis?

Sinusitis can be infectious and non-infectious.  Infectious sinusitis can be caused by a viral infection, bacterial infection (less frequent) or a fungal infection (rare).  Non-infectious sinusitis is caused by irritants or allergies. Allergic fungal sinusitis (not to be mistaken with fungal sinusitis) is caused by an allergic reaction to fungi that are found in the air.

A sinus infection may be caused by anything that interferes with the airflow to the sinuses and drainage of mucus out of the sinuses. Common colds, flu, allergies and irritants such as cigarette smoke can cause swelling of the tissue lining and may block the sinus openings. Blocked sinuses provide an environment for viruses, bacteria and fungus to grow within the sinus cavity.

Fungal sinusitis is very rare. Also known as zygomycosis or mucormycosis, this infection is caused by breathing in fungi from soil or water. Over a few days the fungi can grow and cut off blood supply to tissue, most commonly the nose and eyes. Such infections are very serious and can be fatal and are a medical emergency.  It most likely to effect victims injured in disasters such as tsunamis, hurricanes and earthquakes or in rare instances those with depressed immunity.

What are the risk factors?

There are a number of factors that can make you more prone to sinusitis:-

  • Smoking
  • Allergic rhinitis
  • Asthma
  • Hayfever
  • Cystic fibrosis
  • A weakened immune system eg. Due to HIV or chemotherapy treatment
  • Facial injuries or surgery
  • Infected teeth
  • Inflammatory disorders such as wegeners granulomatosis and sarcoidosis

Common contributing factors to children suffering with sinusitis are allergies, illnesses caught at nursery or school, dummies, drinking from a bottle while lying down and cigarette smoke in the environment.

The most common factors contributing to adult infections are smoking and viral infections.  Other less common contributing factors are bacterial infections, pollution and allergies.  Sometimes an infected tooth can lead to the sinuses becoming inflamed.

Anyone can suffer with allergic fungal sinusitis (AFS) but people who have hayfever or asthma and are in their early 20’s appear to be most at risk.  It is also believed to be more common in hot and humid countries.

How is sinusitis diagnosed?

Most cases of sinusitis will clear up on their own, however, your symptoms are severe and causing a lot discomfort or have not gone after a week or so, see your GP.

Your GP will ask about your symptoms and conduct an examination, looking for signs of facial swelling and tenderness around the sinus area. They may want to examine a nasal secretion to help differentiate between infectious and allergic sinusitis.

If the infection has not responded to initial treatment, diagnostic tests such as nasal endoscopy (a flexible fibre optic tube is used to examine the interior of the nose and sinus openings), allergy testing, CT scan of the sinuses and blood tests may be done.

In the rare case of a fungal nasal infection, early diagnosis is essential. Diagnosis is made by examining a tissue biopsy or fungal culture by a microbiologist or pathologist.

What treatment is there for sinusitis?

Symptoms can be eased with over the counter painkillers such as paracetamol and ibuprofen. Decongestant medicines can help but must not be used beyond the recommended use as they can make symptoms worse.  You may find using a vaporiser or inhaling steam from a bowl more helpful.

If bacterial sinusitis is suspected or symptoms have persisted past 10 days or symptoms are getting worse, you are likely to be prescribed antibiotics. The antibiotic amoxicillin is often prescribed. If, however, you are not improving after 5 days, or you are allergic to penicillin, another antibiotic will be prescribed.

You may also be advised to use nasal sprays, which may contain steroids, to reduce congestion and inflammation together with painkillers to treat headaches, high temperature and facial pain. Mucolytic medication which dissolve or breakdown mucus, may also be recommend.

If treatments have not helped or you have chronic or recurrent sinusitis, your GP may refer you a specialist to consider surgery. Surgery for treating chronic sinusitis is called functional endoscopic sinus surgery (FESS) and is conducted under general anaesthetic. The surgeon will widen your sinuses either by removing tissue (nasal polyps) or by inflating a tiny balloon in the blocked sinuses to open up drainage passages, then removing it.

Where your GP believes your sinusitis has been brought on by an allergy, you are likely to be recommended antihistamines. If, however, you are suffering with AFS, antihistamines will not work. Once AFS has been diagnosed both surgery (to clear out build-up of fungus and mucus) and drug treatment will be prescribed to reduce inflammation, prevent the fungus from returning and treat any secondary bacterial infection.

Successful treatment of fungal sinusitis relies on early diagnosis followed by surgery to remove the unhealthy tissue in addition to antifungal drugs and antibiotics.

How can I prevent sinusitis?

Although sinusitis itself is not contagious underlying causes, such as colds and flu, can be contagious. Take steps to avoid catching such infections by strengthening the bodies immunity. Get regular exercise and maintain a healthy diet. An annual flu vaccination can protect you against the most common flu viruses.

If you suffer with recurrent sinusitis it is a good idea to undergo an allergy test.  If you do discover you have an allergy you can take steps to avoid or reduce contact with the allergen and get advice on the most appropriate treatment to ease symptoms.