• Sinusitis

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    What are sinuses?

    The sinuses are small, air filled spaces inside the cheekbones and forehead. They make some mucus that drains into the nose through small channels.

    What is sinusitis?

    Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection.

     

    What are the different types of sinusitis?

    There are two main types of sinusitis: acute and chronic. Acute sinusitis is inflammation that lasts for less than four weeks while chronic sinusitis lasts for more than 12 weeks.

     

    How do you get acute sinusitis?

    In most people, acute sinusitis develops after a cold or flu-like illness. Viruses that may spread to the sinuses cause colds and flu. In a small number of cases, bacteria ‘add on’ to an infection that started with a virus. In some cases, infection spreads to a maxillary sinus from an infected tooth. In some people, one or more factors are present that may cause the sinuses to be more prone to infection. These include:

    • Allergic rhinitis.
    • Other causes of a blockage to the sinus drainage channels, such as nasal polyps, objects pushed into the nose, or facial injury.
    • Asthma.
    • Cystic fibrosis.
    • Inflammatory disorders such as Wegener’s granulomatosis or sarcoidosis.
    • Pregnancy, which makes you more prone to rhinitis.
    • Smoking.

     

     

    What are the symptoms of acute sinusitis?

    Symptoms of acute sinusitis include:

    • Pain and tenderness over the infected sinus. The pain is often throbbing and worse when you bend your head forward.
    • Both sides of your nose usually feel blocked. Your sense of smell may also go for a while. On the other hand, some people will have runny nose. If the discharge is green or yellow, it is more likely that you have a bacterial infection in your sinuses.
    • A fever may develop and you may feel generally unwell.
    • Other symptoms that may occur include: headache, bad breath, toothache, cough, a feeling of pressure or fullness in the ears, and tiredness.

     

    When do I need to seek medical attention?

    If you have one of the following symptoms:

    • High fever (>102.5º F or 39.2º C)
    • Sudden, severe pain in the face or head
    • Double vision or difficulty seeing
    • Confusion or difficulty thinking clearly
    • Swelling or redness around one or both eyes
    • Stiff neck, shortness of breath

     

    What is the treatment for acute sinusitis?

    • Initial treatment of a sinus infection aims to relieve symptoms since almost everyone will improve within the first seven to 10 days. Non-prescription pain medications, such as acetaminophen or ibuprofen are recommended for pain.
    • Flushing the nose and sinuses with a saline solution several times per day can help to decrease pain caused by congestion.
    • Nasal decongestant sprays, including oxymetazoline (Afrin®) and phenylephrine (Neo-synephrine®) can be used to temporarily treat congestion. However, these sprays should not be used for more than two to three days due to the risk of rebound congestion.
    • If symptoms have not improved in seven to ten days, you should arrange for medical evaluation. You may need further treatment.
    • Nasal glucocorticoids (steroids delivered by a nasal spray) can help to reduce swelling inside the nose, usually within two to three days. These drugs have few side effects and dramatically relieve symptoms in most people.

     

    Are there any complications from acute sinusitis?

    Chronic sinusitis can sometimes develop from an acute sinusitis. This is the most common complication. Chronic sinusitis causes similar symptoms to acute sinusitis but they last longer.

    Other complications are rare. However, they can be serious. For example, infection may spread from a sinus to around an eye, into bones, into the blood, or into the brain. These severe complications are estimated to occur in about 1 in 10,000 cases of acute sinusitis. They are more common with infection of the frontal sinus. Children are more prone to complications than adults.

     

     

    What are the treatments for chronic sinusitis?

    If you have an underlying problem that may have caused your chronic sinusitis, treating this will usually help your symptoms. If you have chronic sinusitis and you are a smoker, you may find that if you stop smoking your symptoms improve. This may especially be the case if you have allergies as well. Scuba divers with nasal or sinus problems should be aware of the possible serious consequences of sinus barotraumas. Flying in an airplane may cause an increase in pain if there is blockage of the sinus drainage channel. This is because with the change in air pressure in an airplane, the pressure does not equalize between the sinus and outside due to the blockage.

     

    A long course of a steroid nasal spray or steroid nasal drops may be advised. Steroids reduce inflammation. In particular, a steroid spray or drops may help where an allergy is thought to play a role. A longer than normal course of antibiotics may be advised (e.g 2 week course). It is often an Ear, Nose and Throat specialist who is the best person to decide whether a long course of antibiotics may be helpful for you or not. Anti-fungal medicines are needed if you have a fungal infection of a sinus.

    Surgery is used mainly if the condition does not improve with the above medical treatments. The main purpose of surgery is to improve the drainage of the affected sinus.
    The most common operation is called functional endoscopic sinus surgery. This involves a surgeon inserting an endoscope into the nose. The endoscope used for this procedure is a thin rigid instrument that contains lenses. The endoscope allows a detailed magnified view of inside the nose. The surgeon can see the opening of the sinus drainage channels. He or she can then remove any tissues that are blocking the drainage of the affected sinus. This can improve sinus drainage and ventilation, and help to restore normal function to the sinus.

     

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