Sinusitis
OVERVIEW
You’re coughing and sneezing and tired and achy. You
think that you might be getting a cold. Later, when the
medicines you’ve been taking to relieve the symptoms of
the common cold are not working and you’ve now got a
terrible headache, you finally drag yourself to the
doctor. After listening to your history of symptoms,
examining your face and forehead, and perhaps doing a
sinus X-ray, the doctor says you have sinusitis.
 Sinusitis
simply means your sinuses are infected or inflamed, but
this gives little indication of the misery and pain this
condition can cause. Health experts usually divide
sinusitis cases into • Acute, which last for 4 weeks or
less • Subacute, which lasts 4 to 8 weeks • Chronic,
which usually last up to 8 weeks but can continue for
months or even years • Recurrent, which are several
acute attacks within a year, and may be caused by
different organisms
Health experts estimate that 37 million Americans are
affected by sinusitis every year. Health care providers
report nearly 32 million cases of chronic sinusitis to
the Centers for Disease Control and Prevention annually.
Americans spend $5.8 billion each year on health care
costs related to sinusitis.
What are sinuses?
Sinuses are hollow air spaces in the human body. When
people say, “I'm having a sinus attack,” they usually
are referring to symptoms in one or more of four pairs
of cavities, or sinuses, known as paranasal sinuses
. These cavities, located within the skull or bones of
the head surrounding the nose, include
- Frontal sinuses over the eyes in the
brow area
- Maxillary sinuses inside each cheekbone
- Ethmoid sinuses just behind the bridge
of the nose and between the eyes
- Sphenoid sinuses behind the ethmoids in
the upper region of the nose and behind the eyes
Each sinus has an opening into the nose for the free
exchange of air and mucus, and each is joined with the
nasal passages by a continuous mucous membrane lining.
Therefore, anything that causes a swelling in the
nose—an infection, an allergic reaction, or another type
of immune reaction—also can affect the sinuses. Air
trapped within a blocked sinus, along with pus or other
secretions, may cause pressure on the sinus wall. The
result is the sometimes intense pain of a sinus attack.
Similarly, when air is prevented from entering a
paranasal sinus by a swollen membrane at the opening, a
vacuum can be created that also causes pain.
SOME CAUSES OF ACUTE SINUSITIS
Most cases of acute sinusitis start with a common
cold, which is caused by a virus. These viral colds do
not cause symptoms of sinusitis, but they do inflame the
sinuses. Both the cold and the sinus inflammation
usually go away without treatment in 2 weeks. The
inflammation, however, might explain why having a cold
increases your likelihood of developing acute sinusitis.
For example, your nose reacts to an invasion by viruses
that cause infections such as the common cold or flu by
producing mucus and sending white blood cells to the
lining of the nose, which congest and swell the nasal
passages.
When this swelling involves the adjacent mucous
membranes of your sinuses, air and mucus are trapped
behind the narrowed openings of the sinuses. When your
sinus openings become too narrow, mucus cannot drain
properly. This increase in mucus sets up prime
conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as
Streptococcus pneumoniae and Haemophilus
influenzae , in their upper respiratory tracts with
no problems until the body's defenses are weakened or
drainage from the sinuses is blocked by a cold or other
viral infection. Thus, bacteria that may have been
living harmlessly in your nose or throat can multiply
and invade your sinuses, causing an acute sinus
infection.
Sometimes, fungal infections can cause acute
sinusitis. Although fungi are abundant in the
environment, they usually are harmless to healthy people
because the human body has a natural resistance to
fungi. Fungi, such as Aspergillus , can cause
serious illness in people whose immune systems are not
functioning properly. Some people with fungal sinusitis
have an allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages also can
lead to sinusitis. If you have allergic rhinitis, also
called hay fever, you can develop episodes of acute
sinusitis. Vasomotor rhinitis, caused by humidity, cold
air, alcohol, perfumes, and other environmental
conditions, also may be complicated by sinus infections.
(Rhinitis simply means runny nose.)
Acute sinusitis is much more common in some people
than in the general population. For example, sinusitis
occurs more often in people who have reduced immune
function (such as those with primary immune deficiency
diseases or HIV infection) and with abnormality of mucus
secretion or mucus movement (such as those with cystic
fibrosis).
CAUSES OF CHRONIC SINUSITIS
It can be difficult to determine the cause of chronic
sinusitis. Some health experts think it is an infectious
disease, but others are not certain. It is an
inflammatory disease that often occurs in people with
asthma. If you have asthma, which is an allergic
disease, you may have chronic sinusitis which may make
it worse. If you are allergic to airborne allergens,
such as house dust mites, mold, and pollen, which
trigger allergic rhinitis, you may develop chronic
sinusitis. An allergic reaction to certain fungi may be
responsible for at least some cases of chronic
sinusitis. In addition, people who are allergic to fungi
can develop a condition called “allergic fungal
sinusitis.”
If you are prone to getting chronic sinusitis, damp
weather, especially in northern temperate climates, or
pollutants in the air and in buildings also can affect
you.
If you have an immune deficiency disorder or an
abnormality in the way mucus moves through and from your
respiratory system (for example, primary immune
deficiency, HIV infection, or cystic fibrosis), you
might develop chronic sinusitis with frequent bouts of
acute sinusitis due to infections. In addition, if you
have severe asthma, nasal polyps (small growths in the
nose), or a severe asthma attack caused by aspirin and
aspirin-like medicines such as ibuprofen, you might have
chronic sinusitis.
SYMPTOMS
The location of your sinus pain depends on which
sinus is affected.
- Headache when you wake up in the morning is
typical of a sinus problem.
- Pain when your forehead over the frontal sinuses
is touched may mean that your frontal sinuses are
inflamed.
- Infection in the maxillary sinuses can cause
your upper jaw and teeth to ache, and your cheeks to
become tender to the touch.
- The ethmoid sinuses are near the tear ducts in
the corner of your eyes. Therefore, inflammation of
these cavities often causes swelling of the eyelids
and tissues around your eyes, and pain between your
eyes. Ethmoid inflammation also can cause tenderness
when you touch the sides of your nose, a loss of
smell, and a stuffy nose.
- Infection in the sphenoid sinuses can cause
earaches, neck pain, and deep aching at the top of
your head, although these sinuses are less
frequently affected.
Most people with sinusitis, however, have pain or
tenderness in several locations, and their symptoms
usually do not clearly show which sinuses are inflamed.
Other symptoms of sinusitis can include
- Fever
- Weakness
- Tiredness
- A cough that may be more severe at night
- Rhinitis or nasal congestion
In addition, the drainage of mucus from the sphenoid
or other sinuses down the back of your throat (postnasal
drip) can cause you to have a sore throat. Mucus
drainage also can irritate the membranes lining your
larynx (upper windpipe). Not everyone with these
symptoms, however, has sinusitis.
On rare occasions, acute sinusitis can result in
brain infection and other serious complications.
DIAGNOSIS
Because your nose can get stuffy when you have a
condition like the common cold, you may confuse simple
nasal congestion with sinusitis. A cold, however,
usually lasts about 7 to 14 days and disappears without
treatment. Acute sinusitis often lasts longer and
typically causes more symptoms than just a cold.
Your health care provider can usually diagnose acute
sinusitis by listening to your symptoms and doing a
physical examination, which includes examining your
nasal tissues. If your symptoms are vague or persist,
your health care provider may order a CT (computed
tomography) scan to confirm that you have sinusitis.
Laboratory tests to diagnose chronic sinusitis may
include
- Blood tests to rule out other conditions
associated with sinusitis like an immune deficiency
disorder or cystic fibrosis
- Cultures (special blood tests) to detect
bacterial or fungal infection
- Biopsy to determine the health of the cells
lining the nasal cavity
TREATMENT
After diagnosing sinusitis and identifying a possible
cause, your health care provider can suggest treatments
that will reduce your inflammation and relieve your
symptoms.
Acute sinusitis
If you have acute sinusitis, your health care
provider may recommend
- Decongestants to reduce congestion
- Antibiotics to control a bacterial infection, if
present
- Pain relievers to reduce any pain
You should, however, use over-the-counter or
prescription decongestant nose drops and sprays for only
few days. If you use these medicines for longer periods,
they can lead to even more congestion and swelling of
your nasal passages.
If bacteria cause your sinusitis, antibiotics used
along with a nasal or oral decongestant will usually
help. Your health care provider can prescribe an
antibiotic that fights the type of bacteria most
commonly associated with sinusitis.
Many cases of acute sinusitis will end without
antibiotics. If you have allergic disease along with
sinusitis, however, you may need medicine to relieve
your allergy symptoms. If you already have asthma and
then get sinusitis, you may experience worsening of your
asthma and should be in close touch with your health
care provider.
In addition, your health care provider may prescribe
a steroid nasal spray, along with other treatments, to
reduce your sinus congestion, swelling, and
inflammation.
Chronic sinusitis
Health care providers often find it difficult to
treat chronic sinusitis successfully, realizing that
symptoms persist even after taking antibiotics for a
long period. As discussed below, many health care
providers treat sinusitis with steroids such as steroid
nasal sprays as well as antibiotics.
Some people with severe asthma are said to have
dramatic improvement of their symptoms when their
chronic sinusitis is treated with antibiotics.
Nose and sinus specialists commonly prescribe steroid
nasal sprays to reduce inflammation in chronic
sinusitis. Although they occasionally prescribe these
sprays to treat people with chronic sinusitis over a
long period, health experts don’t fully understand the
long-term safety of these medicines, especially in
children. Therefore, health care providers will consider
whether the benefits outweigh any risks of using steroid
nasal sprays.
If you have severe chronic sinusitis, your health
care provider may prescribe oral steroids, such as
prednisone. Because oral steroids are powerful medicines
and can have significant side effects, you should take
them only when other medicines have not worked.
Although home remedies cannot cure sinus infection,
they might give you some comfort.
- Inhaling steam from a vaporizer or a hot cup of
water can soothe inflamed sinus cavities.
- Saline nasal spray, which you can buy in a drug
store, can give relief.
- Gentle heat applied over the inflamed area is
comforting.
When medical treatment fails, surgery may be the only
alternative for treating chronic sinusitis. Research
studies suggest that most people who undergo surgery
have fewer symptoms and better quality of life.
In children, problems often are eliminated by
removing adenoids obstructing their nasal-sinus
passages.
Adults who have had allergies and infections over the
years sometimes develop nasal polyps that interfere with
proper nasal drainage. Removal of these polyps and/or
repair of a deviated septum to ensure an open airway
often gives them considerable relief from sinus
symptoms.
The most common surgery done today is functional
endoscopic sinus surgery, in which the natural openings
from the sinuses are enlarged to allow drainage. This
type of surgery is less invasive than conventional sinus
surgery, and serious complications are rare. Surgery
should be considered only after failure of medical
treatment.
RECENT DEVELOPMENT IN SINUS SURGERY
Balloon sinuplasty is a new less invasive procedure
for the treatment of chronic sinusitis. In this method
the opening of the sinus is widened by placing a balloon
in the narrowed opening of the sinus. This is similar to
angioplasty procedures for blood vessels.
Dr. Quoc Nguyen, UCI's nose and sinus specialist, is
one of the instructors for the Balloon Sinuplasty Course
in Southern California.
PREVENTION
Although you cannot prevent all sinus disorders—any
more than you can avoid all colds or bacterial
infections—you can do certain things to reduce the
number and severity of the attacks and possibly prevent
acute sinusitis from becoming chronic.
- You may get some relief from your symptoms with
a humidifier, particularly if room air in your home
is heated by a dry forced-air system.
- Air conditioners help to provide an even
temperature.
- Electrostatic filters attached to heating and
air conditioning equipment are helpful in removing
allergens from the air.
If you are prone to getting sinus disorders,
especially if you have allergies, you should avoid
cigarette smoke and other air pollutants. If your
allergies inflame your nasal passages, you are more
likely to have a strong reaction to all irritants.
If you suspect that your sinus inflammation may be
related to house dust mites, mold, pollen, or food—or
any of the hundreds of allergens that can trigger an
upper respiratory reaction—you should consult your
health care provider who can use various tests to find
out whether you have an allergy and if so, its cause.
This will help you and your health care provider take
the right steps to reduce or limit your allergy
symptoms.
Other activities that can cause sinus problems
include
- Drinking alcohol which causes nasal and sinus
membranes to swell
- Swimming in pools treated with chlorine, which
irritates the lining of the nose and sinuses
- Diving, which forces water into the sinuses from
the nasal passages
You may find that air travel poses a problem if you
are suffering from acute or chronic sinusitis. As air
pressure in a plane is reduced, pressure can build up in
your head blocking your sinuses or eustachian tubes in
your ears. Therefore, you might feel discomfort in your
sinus or middle ear during the plane’s ascent or
descent. Some health experts recommend using
decongestant nose drops or inhalers before a flight to
avoid this problem.
RESEARCH
Scientific studies have shown a close relationship
between having asthma and sinusitis. As many as 75
percent of people with asthma also get sinusitis. Some
studies state that up to 80 percent of adults with
chronic sinusitis also had allergic rhinitis. UCI
conducts and supports research on allergic diseases as
well as bacteria and fungi that can cause sinusitis.
This research is focused on developing better treatments
and ways to prevent these diseases.
Scientists supported by NIAID and other institutions
are investigating whether chronic sinusitis has genetic
causes. They have found that certain alterations in the
gene that causes cystic fibrosis may also increase the
likelihood of developing chronic sinusitis. This
research will give scientists new insights into the
cause of the disease in some people and points to new
strategies for diagnosis and treatment.
Another research study has recently
demonstrated that blood cells from people with chronic
sinusitis make chemicals that produce inflammation when
exposed to fungal antigens, suggesting that fungi may
play a role in many cases of chronic sinusitis. Further
research, including clinical trials of antifungal drugs,
will help determine whether, and for whom, this new
treatment strategy holds promise.
From National Institutes of Health.
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expert, Dr. Nguyen, Please Call 714-456-7017 or click
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