Sinusitis
Sinusitis is an infection or inflammation of the membranes that line the nasal passages and sinuses, the air-filled spaces in the front of the skull.
Most colds – infection with one of the common cold viruses – cause a stuffy or ´bunged up´ nose, which clears up within a few days. But if the sinuses become inflamed, other symptoms such as headache and painful swelling of the face may develop.
Sinusitis may only last a few days (acute sinusitis), or it may be an ongoing problem that, without treatment, never completely goes away (chronic sinusitis).
Babies under one don’t get sinusitis because their sinuses are not fully developed, but it can otherwise affect people of any age.
The sinuses are hollow air-filled spaces in the skull bones. They’re connected to the nose and lined with the same membrane, called mucous membrane, which produces a slimy secretion (mucus) to keep the nasal passageways moist and trap dirt particles.
There are four main sets of sinuses. The frontal sinuses are on either side of the forehead above the eyes. The maxillary sinuses are in each cheekbone. The smaller ethmoid sinuses are behind the bridge of the nose and between the eyes, and the sphenoids are between the upper part of the nose and behind the eyes.
What are the symptoms?
The main symptom of sinusitis is a throbbing pain and pressure in the face, which is made worse by bending forwards. Frontal sinusitis causes pain above the eyebrows, and the forehead may be tender to touch. Maxillary sinusitis causes aching in the upper jaw, teeth and cheeks and may be mistaken for toothache.
Inflammation of the ethmoid sinuses causes pain around and between the eyes and the sides of the nose. Inflammation of the sphenoid sinus can cause earache, neck pain or an ache behind the eyes, at the top of the head or in the temples.
Other typical symptoms include:
- return of a stuffy nose after a cold has cleared up,
- thick yellow or green discharge from the nostrils,
- cold symptoms that don’t respond to treatment,
- a constant foul smell in the nose.
Sinusitis can also cause a high temperature, weakness, tiredness, loss of taste and sense of smell, and a cough that produces mucus, which is worse at night.
Very rarely, the infection can spread to the facial bones or the membranes lining the brain (meningitis). Occasionally, sinusitis can spread to form a pocket of pus (abscess) in an eye socket, the brain or a facial bone.
What causes sinusitis?
Most cold viruses only result in a blocked nose. However, if the mucous membrane lining the nasal passages and sinuses swells up, this can block mucus drainage. Mucus builds up causing the pressure and pain of sinusitis. Bacteria or fungi are more likely to grow in sinuses that can’t drain properly, and bacterial infection often causes more inflammation and pain.
Chronic sinusitis is caused by anything that irritates the lining of the nose over long periods and causes the mucous membrane to swell. Examples include:
- grass and tree pollen,
- cold air,
- alcohol,
- perfumes,
- damp weather,
- allergy to house dust mite, mould,and fungi,
- chronic drug use
People who have allergy-based asthma often have sinusitis as well. Indeed, any problem with the nose that blocks the drainage holes can produce sinusitis. This can include polyps (small nodules of mucous membrane), and injury that causes the bridge to lean to one side (deviated nasal septum).
Tooth and gum infections can spread to the sinuses. Rarer causes of sinusitis include conditions that weaken the immune system such as HIV and cystic fibrosis. Swimming, air pollution and smoking can aggravate sinusitis.
How is sinusitis diagnosed?
The doctor will ask about symptoms, touch parts of the face to find any pain or swelling, and may use a technique called transillumination, where a bright light is held against the cheek or forehead in a dark room. The light should pass through normal sinuses; if it doesn’t, this suggests a blockage.
If the symptoms and physical findings are typical of sinusitis, no further testing is usually needed. If there’s any doubt, it may be necessary to have further tests, including X-rays, MRI (magnetic resonance imaging) or CT (computerised tomography) scans.
Nasal endoscopy may be used to investigate chronic sinusitis. This test involves inserting a flexible telescope with a light on the end into the nostril to examine the inside of the sinuses. A local anaesthetic is usually used.
Treatment (acute sinusitis)
Often sinusitis can be treated with home treatments. Rest, breathing in steam from a bowl of hot water, and over-the-counter medicines should help. Ask a doctor for advice.
Pain killers help to relieve pain and lower temperature. Decongestants and menthol, which can be inhaled, reduce the swelling in the nose and allow the sinuses to drain. Decongestants should not be used for more than a week, as prolonged use can actually make nasal blockage worse in the long run.
Consult a GP if symptoms don’t improve after a week of trying home remedies. The GP may prescribe a course of antibiotics.
Treatment (chronic sinusitis)
Steroid nasal sprays, available on prescription, are helpful in two ways. If long–term infection is present they help to reduce swelling of the nasal lining and open up the drainage holes, and if allergy is involved they also reduce inflammation. Antihistamines might also help.
In severe cases, the GP may recommend a short course of steroid tablets. These are only available on prescription.
Endoscopic nasal surgery may be needed as a last resort. Tubes and instruments passed down a nasal endoscope are used to wash out the sinus and widen the drainage hole. This can be done under general or local anaesthetic. It is a routine and generally safe procedure, but all surgery does carry some element of risk. Complications include minor damage to the lining of the nose or sinuses, or damage to the skull bone.
Other types of surgery sometimes required to treat chronic sinusitis include correcting a bent nasal cartilage (septoplasty) or removing nasal polyps.
Prevention
It is possible to reduce the chances of developing sinusitis. Here are some things that might be helpful, especially for people who are prone to sinusitis:
- keep the air humid at home,
- use an air-filtering vacuum cleaner,
- remove pets,
- have a course of anti-allergy injections,
- stop smoking,
- avoid alcohol,
- use a decongestant spray or tablets before diving or swimming