Sinusitis

Sinusitis

WHAT IS SINUSITIS?

Before we can answer that question, we should talk a little bit about anatomy. Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. Humans possess four paired paranasal sinuses. Your cheekbones hold your maxillary sinuses, the largest. The low center of your forehead is where your frontal sinuses are located. Between your eyes are your ethmoid sinuses. In bones behind your nose are your sphenoid sinuses. They’re lined with soft, pink tissue called the mucosa. Sinusitis means your sinuses are inflamed.

WHAT CAUSES SINUSITIS?

98 percent of sinusitis occurs due to viral infection. It can also be caused by bacterial infection; while a small population can have it due to fungal disease. There are some predisposing factors that make it more likely that you get sinusitis, including

- Allergic rhinitis, which makes it easier for infection to occur.

- Exposure to smoke or cigarette smoking.

- Anatomical abnormalities make it difficult for sinuses to drain.

The central event in sinusitis is blockage of the sinus openings or Ostia, as a result of inflammation. Unable to circulate air and eliminate the secretions that are produced,

obstructed sinuses become an ideal environment for bacterial infection.

TYPES OF SINUSITIS

Types of sinusitis include:

- Acute Sinusitis, which lasts up to 4 weeks.

- Subacute Sinusitis, lasts 4 to 12 weeks.

- Chronic Sinusitis, lasts more than 12 weeks and can continue for months or even years.

- Recurrent Sinusitis, with several attacks within a year.

WHAT ARE THE SIGNS AND SYMPTOMS OF SINUSITIS?

The first thing that most people notice is going to be a pain. The pain may be localized to the sinus involved or it can also cause generalized pain which may present as a headache.

If you tap on the sinus involved with the finger, it can produce tenderness. Also, since the mucosa is inflamed, it will produce lots of mucus, which is going to drain into the nasal cavity through sinus openings or Ostia. Once in the nasal cavity, there are only two things it can do. The first thing is to come out of your nose, so people will notice nasal discharge. The second thing it can do is go to the back of your throat as the back of your nose is related to the back of your throat and there it causes irritation and causes you to cough. Inflammation of mucosa can also alter the smell and taste of things. Patients can also have a fever because of the infection and inflammation.

HOW CAN WE DIAGNOSE SINUSITIS?

By and large, the diagnosis of sinusitis is made by symptoms alone.

Common symptoms include:

- Nasal or postnasal drip

- Sinus pain or pressure

- Nasal congestion

- Decreased ability to smell

- Cough

- Headache and fever.

But sometimes the symptoms aren't clear cut. In that case, there are some other tests that can be done to diagnose.

Sometimes a medical practitioner will take a look inside your nose to get a better look at nasal or postnasal drip. This is called Rhinoscopy. X-rays can be done to visualize sinuses.

The gold standard to diagnose is a CT scan. Other tests are only done if needed in special circumstances.

HOW CAN WE TREAT SINUSITIS?

For acute viral sinusitis, the most common type of sinusitis, there is not a lot we can do

to actually treat the disease itself, but we can treat symptoms. One of the first drugs to treat symptoms is going to be nasal decongestants. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. We also give mucolytics medications that help clear mucus. We also ask the patient to remain well hydrated, as being well hydrated helps in drainage of mucus as mucus formed is not so sticky that it gets stuck in if your body is well hydrated. Finally, we also give pain killers

to help relieve the pain. For acute bacterial sinusitis, we give the entire above plus antibiotics for 10-14 days.

FOR CHRONIC SINUSITIS, again all of the above but the antibiotics have to be given for a lot longer period. Most people recommend 4-6 weeks of antibiotics. If the sinusitis is too severe and the person is at risk of complications, we go for surgery. Surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove growths blocking sinuses, also called polyps. Normally, a thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.