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Family Health Magazine - FAMILY MEDICINE
Sinusitis
More than a simple cold or allergies
Do colds seem to hit you harder than they should? Do you get pain around your eyes or upper teeth along with a thick yellow-green discharge from your nose? With these episodes do you sometimes have a bad cough? Do these symptoms often last longer than 10 days?
Perhaps you’ve had more than a cold or an allergy. You may be experiencing sinusitis. If you are an otherwise healthy adult, here is some information to help you decide.
What are sinuses?
Sinuses are air-filled cavities in the bones of your skull (see diagrams). There are four on each side of your face. They are named after the skull bones in which they occur – the frontal, maxillary, ethmoid and sphenoid sinuses. The size and shape of sinus cavities varies. One person’s sinus may be quite different from another’s. They even may differ in size and shape on one
Each of your sinus cavities is lined with a thin layer of special cells. This layer contains microscopic hairs called cilia (see diagram 1). The cells produce a protective blanket of thick fluid called mucus. Cilia beat in a co-ordinated way to move mucus through each sinus and out of a small opening called the ostium on the inner wall of the nose.
Why do we have sinuses?
Sinuses may have no function at all in humans. However, they may exist to
- reducing skull weight
- making facial bones more rigid
- better distributing air to improve our sense of smell
- adding warmth and moisture to the air we breathe into our lungs
- contributing to the distinctive sound of our voices
- air conditioning the head by providing a greater surface for heat loss.
What is sinusitis?
The term sinusitis refers to any infection or inflammation of the sinuses. Usually, a blockage of the ostium (opening of the sinus) interferes with sinus drainage and ventilation. The most frequent cause of ostium blockage is the common cold. Allergies, polyps or structural abnormalities such as a deformity inside the nose can also cause problems.
Sinusitis is classified as acute, subacute, chronic or recurrent. Acute sinusitis is an infection of the sinuses lasting less than a month. Recurrent sinusitis refers to three or more episodes of acute sinusitis in a year. Subacute sinusitis lasts four to eight weeks, while chronic sinusitis lingers longer than eight weeks.
Changes to the linings of the sinuses are generally reversible after acute infections. If an infection lasts for more than a month or if there are more than three acute sinusitis episodes in a year, it is classified as chronic. In this case, irreversible damage may have occurred. Sinusitis affects about 16 per cent of Americans and is one of Canada’s most frequently diagnosed diseases.
Symptoms
The symptoms of sinusitis vary from one person to the next but generally include
combinations of the following:
- purulent (pus-containing) nasal discharge, especially if it is green
- postnasal discharge (draining in the back of the nose and throat)
- reduced sense of smell
- pain or tenderness in the face or upper teeth
- headache
- cough that is worse at night
- being constantly tired
- occasional fever.
Other symptoms include nausea, bad breath and sore throat. Symptoms of chronic sinusitis are similar to those of acute sinusitis, except that they are less severe, last longer, and respond poorly to standard treatment.
Tests
Sometimes a history and examination alone are not enough to make a definite
diagnosis of sinusitis. If this is the case, your doctor may suggest certain
tests to confirm the diagnosis.
Sinuses can be examined in several ways. An x-ray of the sinus cavities is an inexpensive and readily available test. However, computed tomography (CT scan) provides a more sensitive or detailed view. CT scans are particularly useful when deciding whether sinus surgery will be necessary.
Magnetic Resonance Imaging (MRI) can also provide more detailed information. An MRI exam can be useful in determining the severity of the problem.
Laboratory tests may include a culture of nasal secretions to learn if an organism is causing the problem. Cells taken from the nose can be studied for underlying allergic conditions. Tests may be done to check that the body’s immune system is working properly.
If there are complications or when chronic sinusitis has been diagnosed, your doctor may refer you to an ear, nose and throat specialist. Additional procedures may be suggested. Fibre-optic visualization (endoscopy) allows the doctor to see the nasal cavities and sinus openings (ostia). Tissue biopsies are sometimes needed. These techniques help find the cause of chronic sinusitis – perhaps structural abnormalities, fungal infection or inflammatory growths.
Prevention
Acute sinusitis is a very common complication of a cold. You can avoid developing
sinusitis during a cold or an allergy attack by:
- drinking plenty of fluids to keep nasal discharge thin
- blowing your nose gently, one nostril at a time
- avoiding air travel if possible
- using an oral or nasal spray decongestant, but not for more than a few days.
Treatment
Most of the time, your family doctor can diagnose and treat acute sinusitis. If complications develop, treatment fails, or you experience three or more episodes of sinusitis in a year, you may be referred to a specialist. You may also need special treatment if you have a weakened immune system or a chronic illness such as cystic fibrosis.
Medications
Sinusitis is usually managed with medications. Antibiotics fight the infection, decongestants encourage sinus drainage and painkillers can be used if necessary.
In acute sinusitis, antibiotics are generally only used when symptoms are severe. Ten to 14 days of treatment is usually enough. If no improvement is seen within three to five days, a different antibiotic should be tried. Increasing resistance to penicillin can be managed by using alternate antibiotics. Nasal decongestants are often included in the treatment of acute sinusitis, but antihistamines are not usually recommended. They may help with recurrent or chronic sinusitis that has an allergic component.
Other approaches include expectorants and saline irrigation. Commercial saline (salt) solutions are available in squeeze spray bottles. There is little evidence to support the use of steroid preparations (glucocorticosteroids) in treating acute sinusitis. Since their onset of action is slow, acute sinusitis may resolve before benefits appear.
Chronic sinusitis is a more complex condition resulting from several factors. Treatment begins with searching for and removing blockage of the sinus ostia. Chronic sinusitis may require antibiotics for as long as six weeks. The effectiveness of low-dose antibiotics in preventing recurrent infections has not been well documented. Steroid preparations may be useful for reducing the nasal inflammation and mucus production of chronic sinusitis.
Surgery
If sinusitis does not respond to medication and becomes chronic, surgery
may be recommended. Surgery can remove obstructing tissue or correct structural
abnormalities, allowing the sinuses to drain. Different types of surgery are
possible, depending on the nature of the problem and which sinus is involved.
Some procedures require external incisions, some involve cutting under the
upper lip and others are performed within the nasal cavities.
Complications
Untreated sinusitis can lead to serious complications. Infection can spread to the bones of the face (in osteomyelitis) or to the surface of the brain (in meningitis or epidural abscesses). Infection may also extend to the tissues or veins around the eye. These complications are rare but serious. Sinusitis can make asthma worse.Chronic sinusitis may damage sinus cavities and create chronic symptoms such
as cough and headache. Assuming facial symptoms are due to sinusitis can delay
the treatment of dental problems that may be the true cause. Talk to your
family physician or dentist about your concerns.
Many people suffer unnecessarily from sinusitis. Acute sinusitis can be successfully
treated 95 per cent of the time. Aggressive treatment of chronic sinusitis,
using several different approaches, can significantly reduce if not completely
cure symptoms.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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