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rhinosinusitis, ethmoiditis, maxillary sinusitis, frontal sinusitis, sphenoid sinusitis, sinus infection
Sinusitis is an inflammation of the linings of the sinuses and cavities of the nose.
What is going on in the body?
There are four pairs of sinuses. There are sinuses in the forehead bone, below and between the eyes, and between the back part of the eye sockets.
The sinuses are normally filled with air. The linings of the sinuses are covered with microscopic fingers, or cilia, that direct mucous to the drainage openings within the sinuses.
The function of the sinuses is not clearly understood. In a healthy person, the lining of the sinuses and nose makes about one to one and a half pints of mucous per day. So, a function of the sinuses is to moisten, cleanse, and warm the air as it goes through the nose before it enters the lungs. The normal nose is a wonderful filter. It removes 80 percent (80%) of all tiny particles. Most pollens are usually well filtered from the air. The sinuses also make nitrous oxide, a gas that may be important in keeping the small airways in the lungs open.
Sinusitis occurs when the lining of the nose and sinuses becomes inflamed. Common causes include pollens, animal dander and other allergens. These allergens set off an inflammatory response, releasing histamine and other chemicals. When these substances are released, symptoms occur.
Viruses can also affect the sinuses. Viruses usually cause upper respiratory infections. These viruses attack the lining of the sinuses and cause swelling of the nasal tissues, which leads to symptoms. Most viral infections resolve. About five out of every 1,000 are complicated by a bacterial sinus infection.
Bacterial forms of sinusitis usually occur when the drainage opening is blocked by swelling or narrowing. Then the normal bacteria in the sinus and nasal tracts overgrow and cause an infection.
Other less common causes of sinusitis are pollutants in the air, cold air, dry air, aspirin sensitivity, and long-term use of spray nasal decongestants.
What are the signs and symptoms of the condition?
In acute sinusitis, the symptoms are present for less than 3 weeks. In subacute sinusitis, symptoms are present between 3 weeks and 3 months. The symptoms are essentially the same, but are more severe in acute sinusitis. The symptoms depend on what is causing the sinusitis.
In acute allergic sinusitis, the main symptoms are sneezing, clear, watery discharge from both sides of the nose, tearing, eye itching, nasal congestion, nasal and ear itching, and sometimes coughing. Less frequent symptoms are wheezing, eczema, skin rashes, face pain or pressure. On examination, the nose lining varies from intensely red to a pale pink appearance. The eyes may be red.
Sinusitis caused by a virus will cause a sore throat lasting for 24 to 48 hours, laryngitis, or inflammation of the area containing the vocal cords. This causes hoarseness, nasal stuffiness, fever, chills, sweats, muscle aches and joint pains. The nasal discharge is usually clear and watery. It then becomes thicker and coloured. The colour ranges from white to slightly yellow to green to brown. Face pain and cough may occur. It will spontaneously resolve in 10 to 14 days. Sometimes an episode can last 21 days. Viral sinusitis is common in the autumn, winter and early spring. An examination will show red, swollen nasal tissue, fever and a red throat.
Sinusitis caused by bacteria usually follows an upper respiratory illness caused by a virus or allergies. Symptoms depend on whether the person is a child or adult. In children, bacterial sinusitis symptoms are a green to yellow discharge from the nose, fever, puffy face and redness, cough that is worse at night and nasal stuffiness. Young children often do not complain of face pain or headache. They may be irritable and sleep poorly. Older children may complain of face pain over the sinus that is infected. In adults, the symptoms are discoloured nasal drainage, nasal stuffiness, face pain and headache. The symptoms of bacterial sinusitis follow one of three patterns. The most common is symptoms that worsen over time. The second pattern is symptoms that last longer than 3 weeks. This is often described as a cold that won't go away. The third pattern is the sudden onset of severe upper respiratory symptoms.
People with cold air sinusitis experience sneezing, nasal stuffiness, clear discharge from the nose and face pressure caused by exposure to cold air.
Dry air sinusitis is often seen in the winter months. Nasal stuffiness is common. There frequently is a yellow to slightly bloody crusting especially in the front part of the nose. With non-allergic and aspirin sensitivity sinusitis, people have very thick, white or yellow discharge from the nose, long-term face pain, loss of smell, headaches and frequently have polyps, which are growths that protrude from the mucous membrane.
What are the causes and risks of the condition?
Bacterial sinus infections can cause problems. They can spread into the eye socket and cause an abscess, or pocket of pus. A CT scan is necessary for this suspected condition, which is treated with antibiotics. An infection of the eye socket is a medical emergency. It can lead to blindness if not treated. It requires surgical drainage and intravenous antibiotics.
Acute frontal sinusitis must be followed very carefully. If it does not clear up with oral antibiotics, or antibiotics given by mouth, intravenous antibiotics, or antibiotics given into a vein, are needed. Acute frontal sinusitis can lead to epidural or brain abscess or meningitis, which is an inflammation of the membrane surrounding the brain.
One group needs special mention. Teenage boys with acute frontal and sphenoid sinusitis have a higher rate of infections within the brain. They need to be watched carefully. Early aggressive treatment should be used if they do not respond to oral antibiotics.
What can be done to prevent the condition?
For sinusitis caused by a virus, avoiding crowded places and infected people can lessen the risk of catching a virus. Influenza or flu vaccination can help prevent infection by the influenza virus. Careful hand washing and disposal of tissues can help prevent spread. Prevention of bacterial sinusitis requires preventing the viral or allergic causes that lead to it.
How is the condition diagnosed?
Allergic sinusitis is diagnosed by the symptoms and what may trigger them. The response to antihistamines and other allergy medications is helpful in confirming the diagnosis. Examining nasal secretions may be helpful. Skin or blood testing for a reaction to allergens may be needed to identify the allergens.
Viral sinusitis is diagnosed by symptoms and examination findings. Some viruses can be cultured from the nose.
Bacterial sinusitis is diagnosed by evaluating infected material in the laboratory. Recognising the symptom patterns is also helpful.
What are the long-term effects of the condition?
People with occasional bouts of sinusitis usually have no long-term effects. Those with frequent or long-term attacks develop loss of smell, increasing nasal secretions, chronic face pain or headaches. The lining of the sinuses thickens and blocks the sinus openings. This leads to bacterial sinus infections.
Lingering inflammation of the nose and sinuses can cause postnasal drip and cough. Often, oral corticosteroids, such as prednisone, can help.
aspirin sensitivity can cause inflammation of the mucous membrane that leads to polyp formation.
What are the risks to others?
Since most sinusitis is caused by either a virus or bacteria, there is a risk of infecting others.
What are the treatments for the condition?
Treatment for sinusitis caused by a virus consists of medication to reduce fever and aches, oral or topical, which means placed on the skin, decongestants to improve breathing, and saltwater rinses. Increasing fluid intake is important to keep the nasal secretions thinner.
With bacterial sinusitis, symptoms may resolve using the same measures used for viral sinusitis. Occasionally, oral steroids are needed. If not, antibiotics are used. Rarely, antibiotics fail to help. Then cultures of the nasal secretions are needed.
Treatment for cold air rhinitis is to avoid cold air. Topical steroids and anti-secretion medications help reduce the symptoms.
Treatment for dry air rhinitis includes saltwater rinses, water-based nasal steroids and petroleum-based ointments.
Treatment for non-allergic and aspirin-sensitive rhinitis is oral or topical steroids. Some newer medications block the inflammatory response.
What are the side effects of the treatments?
Side effects depend on the medications used. Brief use of topical decongestants has few side effects. Long-term use can cause progressive inflammation in the nose.
What happens after treatment for the condition?
Most cases resolve by treating the symptoms.
How is the condition monitored?
Careful monitoring is necessary for some infections because the infections can spread to adjacent areas and cause serious harm.
Author: William Stevens, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request