A B C D E F G H I J K L M N O P R S T U V W

SINUSITIS

What is Sinusitis ?

The sinuses are air-containing cavities within the skull bones. They open into the nose through narrow channels. Sinusitis is an infection of these cavities. The sinus which is most commonly the site of infection is called the antrum (maxillary sinus) and is in the cheek bone. The ethmoid sinuses are placed between the eye and the nose and are commonly infected in children. Frontal sinusitis involving the sinus in the forehead is less common. The least common sinus to be infected is directly behind the nose and is called the sphenoid sinus. One or more sinuses may be involved. With maxillary sinusitis the pain may occur in the cheek, around the eye or in the forehead. Sometimes the pain may be felt in the upper teeth and mistaken for toothache. You can feel quite unwell, with a headache and perhaps a stuffy nose. Often a discharge of pus into the nose is not noticed until you are beginning to recover. Swelling of the face over the sinus sometimes occurs but is not usually marked. Some patients have repeated infections and go on to develop chronic sinusitis. Nasal discharge from the back of the nose down the throat may occur constantly. Often the condition will flare up, with acute pain.

How does Sinusitis occur ?

An infection of the sinuses spreads from one in the nose. Most commonly it starts as a common cold. This is a virus infection but very quickly other germs called bacteria will take over. These bacteria can readily spread to the sinuses. Sinusitis sometimes occurs without the preceding virus infection. Dental infections can spread to the maxillary sinus. This occurs because the roots of some of the teeth are very close to the lining of this sinus. Injury to the bones surrounding the sinuses may also cause infection, as may swimming in polluted water.

Why does Sinusitis occur ?

Sinusitis is more likely to occur in patients with allergic and other inflammations of the nose, including polyps. If the partition which separates the two sides of your nose (the septum) is deviated, sinusitis is also more likely. All these conditions produce blockage of the nose and obstruction of the openings into the sinuses. Certain germs are commonly found in the nose and are the cause of the infection in sinusitis. The main ones are streptococci, staphylococci and Haemophilus influenzae.

Treatment involved for Sinusitis

Medical treatment aims to relieve blockage, promote drainage of the sinuses, lower temperature and ease pain. Antibiotics act against the bacteria which cause the illness. Drugs like azythromycin and coamoxiclav are often used. Antibiotic drugs must be taken as prescribed and the course should be completed to get the best results. A course of at least 2 weeks is often needed for sinus infections. Paracetamol or aspirin for adults will reduce fever and ease pain. Antihistamines and decongestants will reduce swelling of the lining of the nose. This allows the sinuses to drain and the infection to settle. Decongestants may be used by mouth or in the form of drops or sprays. Decongestants should not be continued for long periods. Although their use in acute conditions for a week or so is very helpful, prolonged use can actually aggravate nasal blockage. As in all infections, you may feel generally unwell. Rest plays an important part in treatment. If your symptoms do not respond to medical treatment then washing out or draining of the sinuses may be considered. The sinus may be washed out under a local anaesthetic by passing a thin tube into the sinus. If this is not successful or possible then a small operation can be done to make a drainage hole. This may be done by enlarging the natural opening (intranasal antrostomy). This procedure is usually done under a general anaesthetic.

When CHRONIC SINUSITIS develops, x-ray scans of the sinuses will show signs of this chronic infection. The surgeon may then suggest endoscopic sinus surgery done through the nose with fine instruments and telescopes. This is designed to remove any blockage and provide free drainage of the sinus. It is usually done under a general anaesthetic. A drainage hole (antrostomy) is made inside the nose, and infection in the ethmoid sinuses is cleared. This operation offers a high chance of a cure but like many operations is not guaranteed to be totally successful. In patients with chronic maxillary sinusitis it is also often worthwhile. Before reaching this stage it is often possible to help patients with sinusitis by correcting other nasal conditions. Thus straightening the septum or removing polyps may be needed.

During treatment for Sinusitis

Symptoms of sinusitis should readily improve with treatment. If they do not, or if any new symptoms appear during treatment, you must let the doctor know. Sometimes the sinus infection may spread to surrounding soft tissues and form an abscess. In addition to operating on the sinus itself these abscesses will also need to be drained.

After Treatment

Once an acute attack has subsided, it is worth paying particular attention to the factors which may have caused it. This is even more important after a recurrence. Any underlying problem needs to be dealt with.

If Sinusitis is left untreated

Most patients with mild sinusitis would improve and recover without treatment. Some patients, particularly those with severe symptoms, are more likely to develop serious complications if untreated. Such complications are rare.