Sinusitis

What is Sinusitis?

Sinusitis, commonly referred to as a sinus infection, occur as a result of the growth of a pathogenic micro-organism, be it virus, bacteria or fungus,  within the sinuses. This will result in the blockage of the sinus ostium. When the blockage is mitigated, drainage of mucus and pus will occur. This drainage will happen along the nasal passages all the way to the throat or the nostrils. This type of infection can lead to inflammation where there will be an invasion of immune cells resulting in the swelling of the sinus tissue. Therefore, inflammation of the air passages or cavities within the nasal passage is referred to as sinusitis which can be caused by infection, allergy or other irritants. 

sinus

  • What is a Sinus?
  • Types of Sinusitis
  • Statistics
  • Causes
  • Signs and Symptoms
  • Diagnosis
  • Treatment
  • Complications
  • Prevention
  • Conclusion

What is a Sinus?

Sinuses are void, air filled cavities located in the skulls and are connected to the nasal airway passages by a narrow opening in the ostium (bone). Human beings have four of these hollow or void cavities called sinuses:-

  1. Frontal Sinus (located in the forehead)
  2. Maxillary Sinus (located behind the cheeks)
  3. Ethmoid Sinus (located between the eyes)
  4. Sphenoid Sinus (located deep behind the ethmoids)

These four pairs are generally mentioned as the paranasal sinuses and are often reported as a unit. Cells that are found in the inner lining of the sinuses are the epithelial cells, mucus secreting cells and cells that play a role in the immune system like lymphocytes, macrophages and eosinophils.

Sinuses play a role in humidifying and warming the air we breathe in. In addition, it insulates neighbouring structures like the eyes, nerves, etc and increase voice resonance and act as cushion against facial trauma. It also decreases skull weight.

Types of Sinusitis

Sinusitis is categorised in many different ways based on the time period of the condition and the type of inflammation.

Time Period

  • Acute Sinusitis- Less than 30 days
  • Subacute Sinusitis- Over 1 month but less than 3 months.
  • Chronic Sinusitis- Over 3 months.

Type of Inflammation

  • Infectious Sinusitis- generally arise due to uncomplicated virus infection. However, bacteria and fungi  can cause sinus infection although it is quite rare. Subacute and chronic sinusitis generally develop from incomplete treatment of acute forms. 
  • Non-infectious sinusitis- arise due to irritants and other allergy conditions and have the same time span as acute, subacute and chronic as infectious sinusitis.

Statistics

Sinusitis is a common affliction which can affect people at any point of their lives. It usually occurs when irritants in the environment like pollen affects the nasal passages. This is usually the case with hay fever. Other irritants that can cause sinusitis include certain chemicals, use or abuse of nasal sprays (obtained over the counter) and other illegal substances that are taken in via the nose. It is said that approximately 30 million adults are afflicted with this condition.

Causes

Sinusitis may arise when something obstructs or interferes with the air passage into the sinuses and the mucus drainage  out of it. The openings of the sinus called the ostea can be blocked as a result of the swelling of tissue lining and nasal passage tissue. This is seen in common cold, allergy and other conditions brought out by certain irritants. The sinus can be blocked by a tumor or other forms of growth.

Drainage of mucus from the four cavities can be disturbed due to thick mucus secretion as a result of a reduction in hydration (content of water present) which can take place due to a disease like cystic fibrosis. The epithelial cells that are present in this region have hair like structures called cilia which move backwards and forwards in order to propel mucus out of the sinuses. Cilia have the tendency to be easily damaged by many irritants like smoke. When cilia are damaged, mucus drainage from the sinus will be less efficient.

Stagnated or trapped mucus becomes a breeding ground for bacteria, virus and in some patients suffering from AIDS or other immumnodepressive disorders fungus may grow. Additionally, these micro-organisms can bring about blockage of the sinuses. Maxillary and ethmoid sinuses are the most commonly affected sinuses.

Scarcely,  immumnodepressive patients or survivors of disasters like hurricanes, earthquakes, tsunamis, etc, may inspire fungi from the soil or water. In due course, be it a couple of days or weeks, the fungi will grow and will affect the blood supply to almost all the types of tissue present, mainly the tissues of the nose and the eyes. Although, this type of infections are scarce, it can be very fatal and will be in need of instant medical as well as surgical care.

Signs and Symptoms

Common symptoms associated with sinusitis include headache, facial soreness or tenderness, fever, pressure or pain. Nonetheless, only 25% of the patients afflicted with this condition have reported fever with acute sinusitis. Other symptoms that commonly occur include:-

  • Nasal discharge that is discoloured or cloudy
  • Sore throat
  • Cough
  • Nasal congestion
  • Headache when leaning forward due to additional pressure on sinuses.
  • Tooth pain or ear pain
  • Fatigue
  • Bad breath
  • Itchy eyes and sneezing (non infectious sinusitis)

Diagnosis

Sinusitis is generally diagnosed with the help of an examination and past medical records. This is due to the fact that X-rays of sinuses are usually unreliable and other imaging tests such as CT and MRI scans are expensive although they are very sensitive and specific. Thus, sinusitis is diagnosed at its early stages based on clinical findings which may include

  • Nasal passage redness and swelling
  • Purulent drainage from the nasal passages
  • Tenderness to tapping
  • Swelling of eyes and cheeks 

 From time to time, nasal secretions are inspected for cells that will help the doctor assess the condition and help him or her understand if it is an allergic or infectious sinusitis. Allergic sinusitis may show cells like eosinophils whereas infectious sinusitis may show cells like polymorphonuclear cells. If bacterial infection is suspected then the doctor will prescribe antibiotics. It is important to note that antibiotics are prescribed for bacterial infection and are not effective against viral infections.

In some cases, sinusitis does not respond to the preliminary treatment prescribed. That being so, the doctor may require in depth studies which will include CT or MRI scans. In pregnant women, ultrasound has been utilised to diagnose such infections. However, it is not as specific or sensitive as CTs or MRIs. Another technique that can be used is rhinoscopy. This will employ a small flexible fibre optic tube that can be used to look at the back of the nasal passages and ostea to check for blockages and obstructions by swelling or growth.

Occasionally,  a needle aspiration, also known as needle puncture, of the sinus may be required. This procedure is performed to acquire infected material to culture. As a result, one can discover the causative organism or pathogen that is causing sinusitis. However, this type of culture is rarely deemed to be helpful in determining whether a bacterial or fungal infection is causing the condition as the nasal passages are packed with non-infecting bacteria. A needle aspiration is generally undertaken when treatment fail to make one feel better. An otolaryngologist is required to carry out this procedure. Additionally, needle aspiration of the sinuses are said to be fairly uncomfortable where the patient will require local anaesthesia. Some patients may be in need of general anaesthesia. After needle aspiration is carried out, the contents will be sent for culture as well as staining after which the sinus may be rinsed with a solution of saline. This is the most accurate method that is available to diagnose sinusitis.

Furthermore, endoscopy techniques can be utilised to diagnose sinusitis. Rigid and flexible endoscopy can be both used to acquire diagnostic contents from the infected sinuses. Regrettably, even these procedures are said to be uncomfortable and may require the patient to be sedated. In addition, the procedure will be carried out by an otolaryngologist.

Moreover, fungal infections of the sinus is generally diagnosed by biopsy and tissue which will be removed by a surgeon. Other methods include fungal culture and microscopic examination by a trained pathologist or microbiologist.

Treatment

Antibiotics are not required for sinusitis that result from a viral infection. Recurrently prescribed treatment include pain and fever medications, decongestants and mucolytics.

Persisting bacterial infection of the sinus is exhibited by facial pain, nasal discharge (pus like), symptoms that last for more than a week  and patient not responding to over the counter nasal sprays or medications. Acute sinus infection resulting from bacterial invasion is often treated with a course of antibiotics which is aimed at treating common bacteria that can give rise to sinusitis. The five common bacteria that cause sinusitis are as follows:-

  1. Streptococcus pneumoniae
  2.  Haemophilus influenzae
  3. Moraxella catarrhalis
  4. Staphylococcus aureus
  5. Streptococcus pyogenes.

Thus, antibiotics that are known to be effective are able to kill these types of bacteria.

Chronic sinusitis infection generally requires longer courses of prescribed treatments and medications. In addition, the patient may need a sinus drainage technique. This drainage procedure requires a surgeon to operate to unblock the sinuses where patient will be under general anaesthesia. Moreover, antihistamines should not be consumed and avoided. However  if the patient has sinusitis as a result of allergy due to pollen, dander or other environmental allergens, then antihistamines may be prescribed. This patient may use a topical nasal steroid spray which will help in reducing the swelling without drying effects. This is a main advantage over antihistamines; nonetheless, both are used sometimes.

Many individuals develop allergic sinusitis initially and later on develop sinusitis caused by bacterial infections. In these patients, appropriate and early treatment of the allergic sinusitis will put a stop to bacterial sinusitis from developing.

In rare occasions or natural disasters, individuals may acquire fungal infections such as  zygomycosis or mucormycosis which will weaken the patient. Death rates of about 50%-85% have been stated in patients suffering from fungal infections that result in sinusitis. Treatment solely depends on early findings, appropriate surgical procedures, antifungal medications and alleviating other health problems like diabetes.

Complications

Severe life threatening complications due to sinusitis do not occur very frequently. However, there is a slight possibility that the sinus infections can extend into the brain via a wall of a sinus resulting in a life threatening situation  For instance, meningitis or brain abscess are such complications.  Furthermore, other structures in the vicinity of the sinus can become infected too. This can lead to other problems such as osteomyelitis of the skull bones and infection near or around the eye area called orbital cellulitis. Infections leading to death due to bacterial or fungal organisms hardly ever occurs. The patients who are prone to these types of complications are those who have a suppressed immune system and those who have undergone multiple trauma injuries due to natural disasters (relatively rare).

Prevention

Presently, vaccines that are designed against infectious sinusitis are not available. Having mentioned that, there are other types of vaccines available that act against viruses like influenza and bacteria like pneumococci. These organisms can lead to infectious sinusitis. These vaccines that are designed to act against certain pathogens may be effective in reducing or preventing acquiring infectious sinusitis indirectly. However, there are no studies that can prove this theory. No fungal vaccines against infectious sinusitis are available.

Conclusion

Sinusitis, commonly referred to as a sinus infection, occur as a result of the growth of a pathogenic micro-organism, be it virus, bacteria or fungus,  within the sinuses. This will result in the blockage of the sinus ostium. When the blockage is mitigated, drainage of mucus and pus will occur. This drainage will happen along the nasal passages all the way to the throat or the nostrils. This type of infection can lead to inflammation where there will be an invasion of immune cells resulting in the swelling of the sinus tissue. Therefore, inflammation of the air passages or cavities within the nasal passage is referred to as sinusitis which can be caused by infection, allergy or other irritants.

Sinusitis is a common affliction which can affect people at any point of their lives. It is categorised in many different ways based on the time period of the condition and the type of inflammation. Symptoms associated with sinusitis include headache, facial soreness or tenderness, fever, pressure or pain. Severe life threatening complications due to sinusitis do not occur very frequently.
We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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