Sinusitis – inflammation of sinus lining
Sinusitis is inflammation of the sinus lining (“itis” means inflame). Sinuses are referred to the air chamber behind the eyebrows, cheeks and jaw. Sinuses function is to produce mucus. When we breathe in air, there are a lot of particles (including bacteria) will get into our respiratory tract. The mucus will help to clean this particle.
Sinusitis is a common upper respiratory tract infection. Sinusitis occurs due to impaired clearance and obstruction of the osteomeatal complex. Viral or allergic rhinitis may lead to acute sinusitis. Majority of acute sinusitis cases are due to viral infection, only about 20% is bacterial origin. Most of the time, it is caused by virus that cause common cold. The most common causative agents are S. pneumonia, H. influenza, and occasionally S. aureus and Moraxella catarrhalis. Pseudomonas aeruginosa and anaerobes are found to be the ones that cause chronic sinusitis. The cold will lead to the inflammation of the sinus and leads for bacteria accumulation there. As a result, the in swelling sinuses will send signal to the brain which stimulate further mucus production which further blocking the swollen sinuses. This built up mucus will be a great place for the bacteria to grow. It will later cause a sinus infection or sinusitis. Acute sinusitis last within 4 weeks and chronic sinusitis will lasted between 4-8 weeks (>4 weeks). Recurrent sinusitis is when the person has few attacks per year.
Symptoms of sinusitis:
- Fever
- Pain or pressure in maxillary and frontal (forehead), cheek, between eyes or ears. The pain can be either unilateral or bilateral with tender overlying skin. Pain is worse on bending over.
- Nasal congestion and/or thick yellowish or greenish mucus (at times it can be purulent)
- Pain in upper jaw
- Toothache
- Eyelids swelling
- Headache
- Weakness or fatigue
- Cough
Diagnosis:
Diagnosis usually made by proper history taking and appropriate physical examination. Transillumination of the sinuses may be done with a little success because it is not a sensitive test. Routine imaging is not indicated to all cases. However, CT scan turns out to be a more sensitive test (and reliable) compare to plain film x-ray when comes to chronic resistant or complicated sinusitis. By CT scan, air fluid air fluid levels and bony abnormalities can be identified.
Management:
Treatment is aiming to help reduce the symptoms. The disease is usually self limiting.
- Nasal decongestant – this will help to reduce nasal congestion. These medications are available either in oral or spray form and not recommended to use in prolonged period because it may lead to more decongestants and swelling of the nasal passages.
- Antibiotics can be considered if any suspicion of bacterial etiology. In acute cases, amoxicillin and macrolide can be given for 7- 10 days depends on the severity. If the patient has risk for anaerobes or beta lactamase producing organisms (H. influenza and M. Catarrhalis) amoxicillin clavulanate or 3rd generation of cephalosporin is more appropriate. The risk factors include diabetes mellitus, recent antibiotic use or immunocompromised patients. In chronic cases, amoxicillin-clavulanate is given for at least 3-4 weeks together with intranasal glucocorticoid.
- Analgesics or pain relievers may be useful to combat the pain or to reduce sinus discomfort
- Inhaling steam is useful to help reduce nasal congestion
Prevention and lifestyle modification:
- Avoid cigarette smoke (either active or passive) and other air pollutants
- If you have allergic, avoid contact with the irritants or allergens (e.g.: dust, mold or pollen)
- Avoid air travel during an upper respiratory tract infection
- Drink plenty of fluid – it may keep the nasal discharge thin
- Blow your nose gently. Block one nostril while blowing the other will help.
- Get enough rest
Complications are rare but may be serious. The infection can spread involve the CNS (central nervous system) and may cause orbital and periorbital cellulitis.
Reference:
- Tao Le et al. First Aid for the Family Medicine Boards. 2008. McGraw Hill Lange.
- Murray Longmore et al. Oxford Handbook of Clinical Medicine. 7th edition. 2008.
- Health fact sheet from Bristol-Myers Squibb.
Tags: allergic, bacterial, inflammation, sinus, sinusitis, URTI, viral
Technorati Tags: allergic, bacterial, inflammation, sinus, sinusitis, URTI, viral
I recommend nasal irrigation all the time, and love my neti pot dearly.
I am a huge believer in natural cures, and in not jumping to meds or surgery too quickly. However I must say that if things get to the “chronic” stage don’t mess around. See your doctor and then if you get a ct scan make sure you know all your options (it used to be that sinus surgery was the only option. but now there are less invasive choices like balloon sinuplasty).
Great info in this article. Always good to be aware of the big picture.
.-= GDC´s last blog ..Changes in your diet that can help your sinuses! =-.
You may try bayberry bark. It cleanses and heals the sinuses of all putrid matter.
It’s very good when sick with a cold or flu. It heals stomach and throat membranes.