Acute rhinosinusitis: Treatment, symptoms, advice and help

Definition

Acute infection of the mucous membranes of the nose and paranasal air sinuses

Incidence/Age

Acute rhinosinusitis may occur in anyone of any age and usually follows a cold.

Causes

Normally there is a balance maintained between the tendency for the bacteria, which occur in relatively small numbers in the nose and sinuses of healthy individuals, to multiply rapidly and their removal by the clearance of mucus produced by the glands in the nasal and sinus linings. This is achieved by the coordinated beating of thousands of tiny hairs (cilia) which sweep the mucus out of tiny drainage holes into the nose and down into the throat. If this balance is upset bacterial overgrowth will occur and acute infection (rhinosinusitis) will develop.

A variety of factors will interfere with this balance:

Mechanical obstruction to mucus flow and ventilation of the sinuses will predispose to bacterial overgrowth. Distortion in the anatomy may narrow the drainage pathways and cause turbulent airflow. This may be the result of trauma eg: a nasal fracture , or a congenital deformity eg : a deviated nasal septum (the partition between the nostrils). Tumours and foreign bodies in the nose may also cause acute rhinosinusitis due to mechanical obstruction. Allergy leads to swelling and inflammation of the nasal mucous membranes causing mechanical obstruction to sinus ventilation and drainage, which in turn may also lead to infection.

If the cilia which propel mucus do not beat in a coordinated fashion (as a result of congenital abnormality or damage from bacterial toxins or inhaled toxic chemicals ) mucus flow will be interrupted and bacterial overgrowth will result. Conditions which result in the production of excessively thick mucus which the cilia cannot move (Cystic Fibrosis) may also predispose to arrest of mucus flow and result in bacterial overgrowth.

The immune system also has a role in the control of bacterial levels in healthy sinuses and where it is deficient (as a result of congenital abnormalities or in diseases of the blood cells such as HIV or leukaemia) there may be a loss of control leading to bacterial overgrowth.

The roots of some of the upper teeth intrude into the sinuses of the cheek and are covered by very thin bone which may be broken down by dental infection or by the dentist. This can result in the spread of infection to the sinuses of the cheek ( the maxillary antra).

Symptoms/Signs

Acute Rhinosinusitis causes mucus membrane swelling which results in nasal obstruction, with decrease in the sense of smell and taste, and obstruction of the sinus drainage holes. This causes accumulation of mucus and pus in the sinuses which may cause pain and a feeling of pressure over the sinus affected eg: in the eye brows , over the cheeks and teeth and between the eyes. Pain over the back of the head is not usually due to rhinosinusitis. Pus may leak from the sinuses under pressure leading to mucus and pus draining from the front and back of the nose. Acute rhinosinusitis may also cause generalised symptoms of malaise, fever, prostration and a racing pulse. The physical signs of acute rhinosinusitis include swollen nasal mucous membranes, a purulent discharge, fever and tenderness over the sinuses.

Complications of Rhinosinusitis

Although acute rhinosinusitis usually resolves without complication it can result in a variety of problems. Perhaps the commonest complication is the establishment of chronic infection with persistent pain, discharge and nasal obstruction. Infection can also spread to the throat causing pharyngitis and tonsillitis. Sinus infection rarely spreads to the lower air passages as draining pus is usually swallowed and ends up in the stomach.

Occasionally the infection will resolve leaving scarring and closure of a sinus ventilation/drainage hole.