What is sinusitis?

Sinusitis is defined as inflammation of the sinuses which are air-filled cavities found in your forehead (frontal sinus), behind your nose (ethmoid and sphenoid sinuses) and inside your cheeks (maxillary sinus).  In out of every 7 U.S citizens, 1 will be affected by sinusitis. In addition, women are more commonly affected than men.

The sinuses normally produce mucus which is a thin and transparent liquid.  It protects the sinuses from germ by trapping and removing them.  However, an infection can cause excess mucus production, blocking the openings of the sinuses.  On the other hand, cold and allergies can also produce excess mucus which accumulates inside the sinuses, facilitating the growth of bacteria and viruses.

The most common organism responsible for sinus infections are viruses, which go away after 1 or 2 weeks, without treatment.  However, if your symptoms persists for more than 2 weeks, you should consult your doctor.

What are the types of sinusitis?

There are mainly two types of sinusitis:

• Acute sinusitis: This type of sinusitis is of short duration; up to 2 weeks for viral infections and 4 weeks for bacterial infections.  In addition, viruses are the most common organisms causing acute sinusitis.
• Chronic sinusitis: this is when your symptoms last for more than 3 months.  It is often less severe and associated with structural nasal defects or recurrent allergies.  For this type of sinusitis, the most common organisms are bacteria.

What are the risk factors for sinusitis?

Your risk of developing sinusitis increases if you have:

• Allergic rhinitis (hay fever)
• HIV/AIDS
• Cystic fibrosis
• Been exposed to smoke
• Asthma
• Recent upper respiratory tract infection
• A nasal passage defect such as nasal polyp, nasal tumour or a deviated nasal septum

• A history of allergies
• A dental infection

Signs and symptoms of sinusitis

The signs and symptoms of acute and chronic sinusitis are similar except on the duration of symptoms.  In addition, fever is most commonly experienced in acute sinusitis.  Some of the signs and symptoms are listed below:

• Headache
• You may feel a pressure around your eyes, cheeks and forehead (sinus pressure)
• Cough
• Runny or stuffy nose
• A thick, yellow or greenish discharge from the nose or down the throat
• Ear pressure
• Tenderness and swelling around your forehead, cheeks and nose which gets worse when you bend forward
• Toothache
• Fatigue
• Bad breath

Making a diagnosis

The diagnosis of acute sinusitis can be made by taking a thorough history and an appropriate physical examination.  However, for chronic sinusitis additional information are required to make the diagnosis by means of imaging and blood tests.

During the history taking, your doctor will ask questions to know about your symptoms and if ever you have any risk factors for developing sinusitis.  The physical examination will reveal any signs of sinusitis that you have such as tenderness over your forehead, cheek or nose.

The imaging used to diagnosed sinusitis are plain x-rays (plain sinus radiograph), nasal endoscopy, computed tomography (CT) scan and magnetic resonance imaging (MRI) scan. The plain sinus radiograph is used to detect air-fluid levels inside the sinuses.  CT-scan and MRI scan will demonstrate more details about the sinuses. In addition, nasal endoscopy is used to visualize the sinuses directly and to take a sample for culture testing, which will indicate if there is any type of infection present.

Blood tests are also performed to check for elevated white blood cell count (confirms the presence of bacterial infection) and elevated Erythrocyte-sedimentation rate (ESR- which is a marker for inflammation).

Treatment of Sinusitis

Most cases of acute sinusitis resolves on its own, however there are some home-made remedies and medications which can be taken to relieve symptoms:

• Decongestants: it contains phenylephrine which causes your nasal blood vessels to narrow, hence reducing inflammation, swelling and clear up excess mucus.  However, it should be used for a short period of time as it can cause rebound congestion (constant nasal stuffiness)
• Nasal corticosteroid: these nasal sprays are used to reduce inflammation in the nasal cavity

• Saline nasal spray: it is used to rinse the nasal passages
• Pain killers: they are used to relieve headaches or toothaches caused by sinusitis (acetaminophen, ibuprofen and aspirin)

Antibiotics

Antibiotics are used only when symptoms are not improving over the course of several weeks (chronic sinusitis).  When prescribed, it has to be taken over the whole course even if symptoms disappears, else the bacteria will develop resistance against the antibiotic and the next time a stronger one will have to be used.

Home remedies

These methods can help to relieve symptoms:

• Get adequate rest
• Nasal lavage by using specially designed squeeze bottle to help clear the nasal passage
• Moisturise your nasal passage by breathing steam coming from a bowl of hot water while placing a towel over your head.  This will ease mucus drainage.

Complications

Complications of sinusitis are rare but may include:

• Meningitis: this is when the infection spreads to the membranes surrounding the brain and spinal cord
• Osteomyelitis: this occurs when the infection spreads to bones
• Vision problem: when the infection spreads to the eyes, it may reduce your vision or even cause permanent blindness
• Cellulitis: this is when the infection spreads to the skin

Prevention

To reduce the risk of developing sinusitis, you should adopt a healthy lifestyle:

• Eat plenty of fruits and vegetables: this will provide your body with enough vitamins to boost up your immune system
• Wash hands regularly: this is to kill bacteria or viruses on the surface of your hand and avoid transmission to your mouth or nose
• Get you flu shot done every year: this will improve your immune system and protect you from getting infected
• Avoid exposure to allergens such as pollen, smoke, chemicals, animal fur or mould
• Wear a facemask when in presence of a person who is sick and coughing

Prognosis

Most sinus infections resolves on its own within 2 weeks and these infections are treatable.  However, if your symptoms persist for more than 2 weeks, you need to visit your doctor’s office so that a proper evaluation is done and a proper treatment plan started.  This will prevent complications which may arise if sinusitis is left untreated.

J. Alastair, I. and Simon, M., 2016. Davidson’s Essentials of Medicine. 2nd ed. London: ELSEVIER.

Parveen, K. and Michael, C., 2017. Kumar & Clarks Clinical Medicine. 9th ed. The Netherlands: ELSEVIER.

Brook, I., 2020. Acute Sinusitis.