Sinusitis

Sinusitis encompasses a large group of diseases. It occurs when the lining of the nose and paranasal sinuses (mucosa) become inflamed or irritated. When severe enough, this inflammation can block the small openings of the sinuses or sinus ostia, trapping the mucus inside.

When filled with wet mucous, the sinuses create ideal conditions for organisms to grow. Infectious bacteria and fungal organisms can cause additional tissue inflammation and swelling. This can slow normal mucous clearance within the sinus, further propagating the cycle of inflammation and infection. Infected and/or swollen sinus cavities cause the major symptoms of what most people call sinusitis.

Symptoms of Sinusitis

The common symptoms of sinusitis are:

  • Nasal obstruction or nasal congestion
  • Thick & discolored drainage
  • Decreased smell or taste
  • Facial pain or pressure
  • Facial pressure or fullness

Less common symptoms include:

  • Headache
  • Fatigue
  • Bad Breath
  • Fever
  • Upper tooth pain
  • Cough
  • Ear pressure

Sinusitis shares many symptoms with other nasal and sinus conditions. Since this often creates confusion, a Rhinologist (sinus doctor) or Otolaryngologist (ENT) can help determine the correct diagnosis and establish an appropriate treatment plan for your condition.

Causes of Sinusitis

Anatomic, genetic, and environmental factors can contribute individually or jointly to the development of sinusitis. Anatomic factors shape the sinus drainage pathways. Genetic factors determine how your bodies’ immune system reacts to the environmental factors that can affect the sinuses.

Sinusitis often develops after a cold, when the lining of the nose and sinuses becomes inflamed. This leads to swelling of the drainage pathways and blockage of the sinus ostia. Anatomic variations in the structure of the nose and sinuses may cause sinusitis as well. Cells can block drainage pathways, tightening or limiting the openings even more.

The major sinuses in the front of the nose—the ethmoid, maxillary and frontal sinuses—all drain into a pathway called the ostiomeatal complex region. This area can also narrow due to enlargement of the turbinates or a deviated nasal septum.

Hereditary disorders such as cystic fibrosis and certain autoimmune diseases may also make patients prone to developing sinusitis. Immunocompromised states caused by medications, human immunodeficiency virus (HIV) infection or chronic illnesses such as diabetes may predispose patients to sinus infections.

Environmental factors can irritate and inflame the nasal cavity’s mucous membranes and lead to sinusitis. These factors include exposure to smoke, allergens, and pollutants in the air.

Types of Sinus Infections

Sinusitis is classified into three groups:

Acute infections usually last less than four to six weeks. This is the most common type of sinus infection. Symptoms include nasal congestion or blockage, thick nasal drainage, facial pain, and pressure. This infection occurs most commonly following a cold (virus) that gets more complex. A course of antibiotics can often help treat these infections.

Subacute sinus infections last between four and twelve weeks. Patients with this type of infection often have an increased amount of swelling (inflammation) as a result of the tissues’ response to the first acute infection. Fatigue, cough, decreased the sense of smell and nasal blockage are the most common symptoms.

Chronic sinus infections last longer than twelve weeks. Patients with these infections often go to ENT surgeons after many courses of different medications have failed to clear up symptoms. Sinusitis that persists for longer than three months is often not related to bacterial infections any longer. Instead, it is more likely due to chronic swelling or inflammation of the tissues, which closes the sinus drainage holes (ostia) and does not allow clearance of the normal sinus fluids. These fluids may then get secondarily infected.

Diagnosis of Sinusitis

When visiting your Otolaryngologist (ENT), you may undergo a nasal endoscopy. This procedure is performed in the physician’s office and requires no sedation or general anesthesia.

To make the endoscopy more comfortable, the ENT may apply a spray to your nose containing a decongestant and a topical anesthetic medication. While the anesthetic numbs your nasal lining, the decongestant helps it shrink, which allows a scope to enter more easily. The scope used for a nasal endoscopy is a lighted tube that allows the ENT to see the structures in the nose and sinuses better.

Nasal endoscopes can help your Rhinologist/ENT see the anatomy of your nose, swelling of the nasal/sinus lining, abnormal drainage from the sinus cavities, nasal polyps or other findings. They also allow your physician to take appropriate cultures from infected secretions. This helps the physician diagnose the bacteria that caused the infection and choose the antibiotics to treat it. If necessary, biopsies and other indicated procedures can also be performed via nasal endoscopy in the Otolaryngologist’s office.

Radiologic Studies

CT Scan

After treating sinusitis with antibiotics or other medications, your physician may obtain a CT scan to evaluate the effectiveness of the medicines in clearing the infection and determine the need for any additional therapy. Also, if the disease presentation does not fit usual symptom patterns, a CT may be obtained to better guide therapy. If more serious complications of a sinus infection are suspected such as spread to the orbits (eye) or brain, a CT scan may aid in diagnosis as well.

Limitations of Radiologic Studies

While CT scans can help diagnose sinus problems and guide treatment, any radiologic study is simply a picture taken once. Symptoms can change over time, which may lead your physician to recommend additional studies later. Also, bacterial sinusitis and viral upper respiratory infections show the same abnormalities on a CT scan. For this reason, the diagnosis and treatment of the early-stage infections focus more on studying specific symptoms and their duration.

Can Sinusitis Be Cured?

A course of antibiotics can treat acute sinusitis. However, most of the milder episodes of acute sinus infection will clear up without prescribed medication. Patients can also reduce some of the symptoms with over-the-counter medications.

Subacute infections, on the other hand, often require several weeks of treatment. They may require courses of steroids to decrease the swelling of tissues to open the ostia and drainage pathways.

Chronic sinusitis is often incurable, but treatment can decrease many of the symptoms to tolerable levels. Patients with chronic sinusitis will usually have a wide range of symptoms, some of which may result from damage to the sinus tissues. For example, some patients with chronic sinusitis will lose their sense of smell (and sometimes taste) due to damage to the nerves at the top of the nose during the illness.

Like diabetes or hypertension, chronic sinusitis needs ongoing treatment to control its symptoms. Maintenance therapy is often required to prevent relapse of the disease and keep the sinuses as calm as possible.