Sinusitis

Sinusitis is a condition that is characterised by the inflammation of the mucous membranes in the paranasal sinuses. During sinusitis, inflammation of the lining of the nasal sinuses occurs to an extent that it prevents their drainage. Once sinuses become blocked they can no longer effectively remove bacteria from the sinus cavity. It has been estimated that about 30% of the population of the United States will experience a form of sinusitis at some point during their lives. Of these sinusitis sufferers, about 70% will have an associated allergic condition, including asthma.

Over time, a sinusitis condition may become categorized as acute or chronic. Acute sinusitis can last up to one month and generally affects the large maxillary sinuses, which will typically develop a bacterial infection. If sinusitis persists for longer than three months then it is considered chronic. Chronic sinusitis is a more serious condition often associated with noticeable changes in the mucous membrane. Gradually the lining of the sinus deteriorates due to the bacteria that has become trapped in the sinuses. Bacteria will thrive in this enclosed environment and a pus-filled abscess may develop in the sinuses as a result.

The sinuses are air-filled cavities that are found in the bone structure of the skull, reducing its overall weight. Normally the sinuses help to moisten and warm the air in the nasal cavity. They also provide a degree of resonance that enables us to make certain sounds when we sing or speak.

There are four main sets of sinuses. The frontal sinus is located at the front of the head above each eyebrow and is rarely involved in cases of sinusitis. The sphenoid sinus, on the other hand, is more prone to being affected by sinusitis and is located towards the back of the head. The sinuses most associated with sinusitis are the maxillary sinuses, which are located in the cheeks on either side of the nose, and the ethmoid sinuses located between and behind the eyes.

Each sinus is lined with small hair-like cilia. They move the mucus out of the sinus by means of a wave-like motion, directing it towards the tiny opening in the top of the sinuses called the ostium which serves to drain the mucus away. During the early stages of a sinus infection, the cilia become unable to clear the mucus and the remaining mucus builds up in the sinuses. This is especially true if someone is constantly exposed to cigarette smoke which tends to paralyse the cilia and dehydrate the sinuses.

Sinusitis occurs when the ostium, which is part of the ostiomeatal complex located to the side of each nasal cavity, becomes blocked and prevents drainage. This blockage can be caused by the presence of a foreign body, the drying out of mucus, physical abnormality such as septal deviation, or swelling, especially of the middle turbinate, caused by an allergy or a cold. If the sinusitis is caused by an infection it will most likely occur in the period following a common cold. The most frequent cause of sinusitis is when the ostium becomes obstructed due to the swelling allergic rhinitis engenders and this is why allergic rhinitis is considered responsible for as many as 50% of all cases of sinusitis.

Those symptoms that are typically associated with the common cold, including coughing, tiredness, fever, and intestinal discomfort, may be indicative of sinusitis. Long-term sinusitis may be detrimental to the state of a person's immune system, resulting in a feeling of fatigue or general malaise. In some cases, sinusitis is also believed to contribute to the frequency of migraines.

The buildup of mucus in the back of the nose due to sinusitis can lead to the irritation and inflammation of the throat. This mucus commonly has a green-yellowish colouration. Because of the amount of mucus passed down the back of the throat, bad breath and a persistent unpleasant taste in the mouth may be caused by this constant mucopurulent postnasal drip.

A patient with acute sinusitis may experience pain in the areas of the face that contain the sinuses and a nasal discharge that contains both mucus and pus. Those with chronic sinusitis may develop hyposmia, which is a reduced sense of smell associated with persistent nasal blockage. Sometimes the chronic sinusitis itself is the result of the existence of small nasal polyps that have formed and eventually block the sinus cavities.

Sinusitis creates a feeling of stuffiness and the sensation of pressure on the nasal region of sufferers. Because the nose is often blocked, sufferers commonly breathe through their mouth when they sleep, meaning that the air is no longer filtered through the nose. If the person has an allergy to airborne allergens like pollen or mould, or they have asthma, then this may worsen their condition.

When someone has an allergic condition like allergic rhinitis it actually means that IgE (Immunoglobin E ) antibodies mistake a harmless allergen for a dangerous intruder in the body, prompting chemicals, including histamine, to be released into the body from mast cells. Allergies typically produce a wide range of symptoms, including nasal congestion or a runny nose, sneezing, red and watery eyes, and an itchy throat. An itchy nose, eyes ears and palate are much more prominent symptoms of allergic rhinitis than they are with a common cold. Unlike the thick nasal discharge encountered during the common cold, the rhinorrhoea discharge produced by allergic rhinitis usually has a very watery consistency.

Sinusitis and allergic rhinitis may appear to have similar symptoms but rhinitis is related to the inflammation of the lining of the nose, not the sinuses. If allergic rhinitis is not properly treated, however, it can lead to sinusitis. Mucosal changes in the paranasal sinuses occur in over half of all cases of allergic rhinitis so this can not in itself be taken as indicative of infective sinusitis.

Sinusitis is difficult to diagnose, especially in its early stages, because of the similarity of some of its symptoms to other conditions. A doctor will take into account a patient's medical history and may include a physical exam. A skin prick test or Radioallergosorbent (RAST) test may be used to determine whether allergic rhinitis is a factor in the condition. A medical instrument called an endoscope may be used to examine the inside of the nose. X-rays or a CT scan may be taken if the patient fails to respond to more conservative treatments of their condition. X-rays are generally unhelpful in diagnosing sinusititis, however, and CT scans are not done as routine.

If an allergy is the primary cause of the sinusitis then taking antihistamines and decongestants can be beneficial in treating it. It is a good idea to keep your fluids up while taking the antihistamines to prevent the further drying out of the mucus. Reducing your alcohol intake may also be helpful because alcohol acts as a diuretic and can cause further dehydration.

Nasal sprays can be used to treat runny or itch noses and Atrovent nasal spray, is particularly helpful if sinusitis is causing a large amount of mucus to be produced. If the problem is that the mucus is tending to become dried out then a saltwater based nasal spray can assist with rehydrating and moistening the nose. This saltwater irrigation will thin out the mucus and assist with its drainage. Eye drops can be used to treat itchy, red, and irritated eyes.

While the causal relationship between sinusitis and asthma remains unclear, the two conditions have shown to frequently co-exist, with more than half of all asthma sufferers also having allergic rhinitis. It has been estimated that about half of all asthmatics will exhibit evidence of sinusitis in radiographic examinations. Although a causal link has not been ascertained, is now widely accepted by the medical fraternity that treating rhinitis or sinusitis can be beneficial to sufferers of asthma.

If a patient does not respond to initial treatment, antibiotics may be prescribed by a doctor to combat the existing infection. If the chronic sinusitis is serious and does not respond to other treatment then surgery may eventually be required. Surgery, however, may only provide a short term solution if the underlying allergic reactions that were responsible for the condition are not successfully dealt with.