Sinusitis

Sinus infection or sinusitis occurs when the air-filled spaces in the skull called sinuses get inflamed or swollen. According to a survey by The National Institute of Allergy and Infectious Diseases (NIAID), an estimated 134 million Indians suffer from chronic sinusitis. These numbers are surprisingly double the number of people with diabetes in India.

Other names #

Also known as sinus infection, rhinosinusitis

Causes #

• Your sinuses are hollow spaces or cavities within the bones of the skull that connect to the nose through small, narrow channels.

• Sinuses are located behind the forehead, nasal bones, cheek bones, and in between the eyes.

• They contain mucus, which is a thin liquid that traps and moves away any germs, dust, pollutants and allergens entering the body through the nose. They also help to keep the air you breathe in, warm and moist.

• Healthy sinuses are filled with air. Sinusitis or inflammation of sinuses happens when fluid builds up in these air-filled sinuses, allowing germs to grow and cause an infection.

The causes of sinusitis can include various pathogens, environmental factors to irritants which are:

• Allergens

• Irritants (animal dander, polluted air, smoke, and dust)

• Bacteria

• Viruses

• Fungi

Types Of Sinusitis #

The different types of sinusitis classified according to the timespan of symptoms are:

Acute Sinusitis #

Symptoms usually last for 4 weeks or less. Cases mostly begin with symptoms of common cold such as a runny nose and facial pain. They are usually caused by viral or bacterial infections, or sometimes even seasonal allergies.

Subacute Sinusitis #

Symptoms last from 4 to 12 weeks. This condition commonly occurs due to bacterial infections or seasonal allergies.

Chronic Sinusitis #

Symptoms last more than 12 weeks despite medical treatment, and can continue for months or even years. They are often mild in severity. Bacterial or fungal infection, persistent allergies or structural nasal problems can usually cause this condition.

Recurrent Sinusitis #

Characterised by several attacks of sinusitis within a year.

Symptoms Of Sinusitis #

Depending on which sinus is involved, sinusitis causes pain along with a feeling of pressure:

• In the forehead

• Over the cheek

• In the upper jaw and teeth

• Behind the eyes

• At the top of the head

Other common symptoms that can be seen along with the pain include:

• Blocked nose

• Nasal discharge

• Mucus dripping down the throat (post-nasal drip)

• Sore throat

• Cough

• Bad breath

• Reduced sense of smell and taste

• Fever

• Frequent headaches

• Fatigue

• Pain in upper jaw and teeth

• Ear pain

Diagnosis #

CT Scan (PNS Coronal) or MRI (PNS) #

Images taken using CT or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical blockage, such as polyps, tumors or fungi, that’s difficult to detect using an endoscope. This is why a coronal CT scan or MRI is recommended for the diagnosis of sinusitis.

Microbial cultures #

This test is requested in order to know the cause of the sinus infection in case of a bacterial or fungal infection. It is mostly advised in chronic sinusitis and in cases where the condition fails to improve or worsen even after treatment.

Nasal endoscopy #

In this, a thin flexible tube (commonly known as an endoscope) with a light is inserted through the nose to check the inside of the sinuses.

Tests for Allergies #

If your doctor suspects that the condition might have been triggered due to an allergy, then allergy testing might be advised. It is a simple skin test which helps to detect the allergen that causes a flare-up. It is a quick and safe test that can help you to know about any specific allergen which can trigger a flare-up.

Biopsy #

Although rare, your doctor might advise a biopsy if he/she suspects fungal sinus infection which can even penetrate through the bone. This can only be determined through tissue biopsy or bone biopsy based on the severity and the cause.

Treatments #

Antibiotics #

If you suffer from bacterial sinus infections, then antibiotics are the most preferred and effective treatment that is recommended. Based on the symptoms and severity of the infection as well as the type of the antibiotics, it can be recommended from one week upto two weeks and beyond if there are any complications. In case of chronic infections, the treatment duration might be prolonged as well. However, do not self-medicate as it can increase the risk of antibiotic resistance. Some of the commonly recommended antibiotics include:

• Amoxicillin

• Trimethoprim-sulfamethoxazole

• Cefuroxime

• Clindamycin

• Ciprofloxacin

• Sulfamethoxazole

• Metronidazole

Decongestants #

These medications help treat sinus infections by causing the swollen nasal passages to shrink. This in turn helps in the proper flow of drainage from the sinuses. These are available in the form of pills, nasal sprays as well as topical ointments. Examples of the commonly used decongestants for sinusitis are:

• Naphazoline

• Oxymetazoline

• Adrenaline

• Oxymetazoline+Sorbitol

• Phenylephrine

Antihistamines #

If the cause of the sinus infection is an underlying allergic reaction or due to an allergen, then antihistamines are the preferred medications. These medications work by blocking the inflammation that causes the allergic reaction and help to fight the symptoms. These also help to treat swollen nasal as well as sinus passages, improving the condition. Examples include:

• Cetirizine

• Chlorpheniramine

• Clemastine

Pain relief medications #

As the name suggests, pain relief medications help in treating headaches which often accompany sinus infections. These are also known to help improve the symptoms and are mostly given along with other medications to treat the infection. Examples include:

• Paracetamol

• Ibuprofen

Nasal corticosteroids #

These are available as nasal sprays which help to prevent and treat inflammation. Some of the common examples of medicine which belong to this class are:

• Fluticasone

• Fluticasone propionate

• Triamcinolone

• Budesonide

• Mometasone

• Beclomethasone

Oral or injected corticosteroids #

These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Commonly used corticosteroid is:

• Prednisolone

Other options #

Saline nasal irrigation with nasal sprays or solutions reduces drainage and rinses away irritants and allergies. Additionally, use of heat pads on the inflamed area to soothe the pain or vaporizers to improve flow of mucus from the nose and relieve the symptoms is also recommended.

Surgery #

If drug therapies fail to show any improvement in your condition, then surgery may act as a last resort. It is mostly done in people suffering from sinusitis caused due to underlying anatomical defects. An otolaryngologist (ENT Surgeon) is the right doctor who can fix defects in the bone separating the nasal passages, remove nasal polyps, and open up closed passages.