Sinusitis

Description

Sinusitis is an inflammation of the mucous membrane in the sinuses. It can occur in both acute and chronic forms.

In sinusitis, any part of the sinuses can become inflamed: the maxillary sinus (sinusitis maxillaris), the frontal sinus (frontal sinusitis), the sphenoid sinus (sinusitis sphenoidalis) and the ethmoid bone (sinusitis ethmoidalis). If sinusitis affects several or all sinuses at the same time, this is called polysinusitis or pansinusitis.

Symptoms

When sinusitis develops suddenly, the symptoms are similar to the beginning of a common cold. The two symptoms most important in acute sinusitis are pain and a feeling of congestion in the face. The nasal discharge in acute sinusitis is usually suppurative, yellow-greenish colored and viscous. The nose is so swollen that the affected person can hardly breathe through it, can no longer perceive scents properly, and food tastes less intense. In addition, acute sinusitis can cause general symptoms such as fever. Besides these main symptoms, acute sinusitis can trigger secondary symptoms including headache, fatigue, toothache, cough or earache.

Causes and Risks

Sinusitis can have various causes. Acute sinusitis usually develops after a cold or a sore throat, whose most common triggers are viral. Acute sinusitis can also occur as so-called "bath sinusitis" in which case the pathogenic agents come from the water and enter the nose while bathing. Other possible causes of acute sinusitis are diseased tooth roots or a tooth extraction in which a connection is made between the cavity in the maxillary sinus and the oral cavity (fistula).

But acute sinusitis is not always provoked by infection: allergic rhinitis may also cause it. And so-called barosinusitis (also: aerosinusitis) is caused by pressure fluctuations when flying and diving.

Risk factors for the development of acute sinusitis include a weakened immune system, unusually aggressive pathogens, shifted or narrowed paranasal sinuses, and anatomical anomalies such as a bent nasal septum or enlarged turbinates.

Examination and Diagnosis

Endoscopic examination enables the safe diagnosis of sinusitis. Endoscopic examination also shows whether anatomical changes are present. During the procedure, the doctor can if necessary extract secretions (e.g. by puncturing the maxillary sinus) to directly verify what pathogen is causing sinusitis. He may then under certain circumstances prescribe a drug that specifically targets the pathogen.

Among the examination imaging methods available, computed tomography (CT) is the most significant for the diagnosis of sinusitis. Ultrasound and X-rays are no longer generally recommended, but may be useful in certain cases (e.g. examination during pregnancy). Additional blood tests, allergy tests, olfactory tests and dental checks may in some cases also be useful for chronic sinusitis.

Treatment

Medications and other non-surgical measures may be useful in relieving the symptoms of sinusitis. Often the symptoms of acute sinusitis will abate on their own within about two weeks, without treatment. In some cases - especially cases of chronic sinusitis - a surgical procedure is nevertheless necessary to control recurring, debilitating inflammations and to cure the disease.

Conservative treatment may involve decongestant nose drops (possibly with cortisol) or cotton wadding, soaked in decongestants, inserted into the middle nasal passage. Drugs that act as expectorants, anti-inflammatories and (if applicable) antipyretics can help against the symptoms of acute sinusitis. Since viruses mostly cause acute sinusitis, antibiotic treatment is rarely helpful. Antibiotics (esp. with the agent amoxicillin) will make a difference only if there is evidence that bacteria are responsible for the inflammation, and if at the same time a number of other specific conditions are met.

For support with sinusitis it may be helpful to inhale warm steam (about 42 to 45 degrees Celsius) after each application of decongestant nasal drops. Essential oils should not be applied. Although many people find that infrared radiation or high-frequency wave therapy feels pleasant, the efficacy of these treatments has not been scientifically proven. In a case of acute sinusitis it is not recommended to rinse out the nose, as there is no evidence of any positive effects.

If an allergy is responsible for chronic sinusitis, anti-allergic agents and nasal sprays containing corticoid can be used for treatment. It is often also advisable to carry out immunotherapy. Nasal douches may help relieve symptoms.

Course and Prognosis

Acute sinusitis has a good prognosis and usually develops without serious complications if proper treatment begins in good time. Chronic sinusitis on the other hand can have a lengthy course and may ultimately require surgery.

Miscellaneous/Other Comments

Although acute sinusitis rarely causes complications (e.g. post-nasal drip, inflammation of adjacent tissues etc.), these can be severe and without treatment may lead in some cases to permanent damage.