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Sinusitis: Treatment, symptoms, advice and help

About Sinusitis

Sinusitis is the inflammation of the paranasal sinuses due to an allergy or an infection. There are four pairs of paranasal sinuses - frontal, ethmoid, maxillary and sphenoid.

Sinusitis: Incidence, age and sex

Acute bacterial sinusitis may occur at any age, but it is more common in childhood and adolescence. Approximately 0.5 – 2% of viral upper respiratory tract infections in children and adolescents are complicated by acute bacterial sinusitis. Roughly, ninety percent of adults have had sinusitis at some point in their life.

Signs & symptoms of sinusitis: Diagnosis

Children and adolescents with sinusitis may present with non-specific complaints, including nasal congestion, purulent nasal discharge, high temperature and cough. Less common symptoms include bad breath, a decreased sense of smell, and periorbital oedema. Headache and facial pain are rare in children but common in adults. Other symptoms include maxillary tooth discomfort, pain or pressure exacerbated by bending forward, and decreased sense of smell. Physical examination may reveal redness and swelling of the nasal mucosa with purulent nasal discharge. Sinus tenderness may be detectable in adolescents and adults.

The clinical diagnosis of acute bacterial sinusitis is based solely on history.

Causes and prevention of sinusitis

The bacterial pathogens causing acute bacterial sinusitis include Streptococcus pneumonia, Haemophilus influenzae and Morazella catarrhalis. Predisposing conditions include viral upper respiratory tract infections, allergic rhinitis, and cigarette smoke exposure. Children with immune deficiencies, cystic fibrosis, abnormalities of phagocyte function, gastroesophageal reflux, anatomical defects like cleft palate, nasal polyps and nasal foreign bodies (including nasogastric tubes) can develop chronic sinus disease. Patients with nasotracheal intubation or nasogastric tubes may have obstruction of the sinus ostia and develop sinusitis.

Prevention is best accomplished by frequent hand-washing and avoiding persons with colds. Because acute bacterial sinusitis may complicate influenza infections, prevention of influenza infection by yearly influenza vaccine, is recommended.

Sinusitis: Complications

Orbital (eye) complications, including periorbital and orbital cellulitis are secondary to acute bacterial ethmoiditis. Intracranial complications can include epidural abscess, meningitis, cavernous sinus thrombosis, subdural emphysema, and brain abscess. Other complications include osteomyelitis of the frontal bone and mucoceles.

Sinusitis: Treatment

50 – 60% of children with acute bacterial sinusitis recover without antimicrobial therapy. Initial therapy is with amoxicillin, trimethroprim-sulfamethoxazole, cefuroxime axetil, cefpodoxime, clarithromycin, or azithromycin. Use of decongestants, antihistamines, mucolytics, and intranasal corticosteroids may also help.

For chronic or recurring sinusitis, treatment options may include nasal surgery by an ENT specialist called functional endoscopic sinus surgery (FESS). This surgery removes anatomical and pathological obstructions and restores normal clearance of the sinuses.