Sinusitis



Overview:

"Sinusitis" simply means the sinuses are inflamed―red and swollen―because of an infection or other problem. There are several types of sinusitis. Health experts usually identify them as:

  • Acute, this can last up to 4 weeks.
  • Subacute, this can last 4 to 12 weeks.
  • Chronic, which lasts more than 12 weeks and can continue for months or even years.
  • Recurrent, with several attacks within a year.

In 2009, the Centers for Disease Control and Prevention reported that nearly 31 million adults were diagnosed with sinusitis. Women were almost twice as likely as men to receive the diagnosis. People with chronic sinusitis often relate their quality of life as decreased, even worse than sufferers of chronic back pain.


Screening/Diagnosis:

Symptoms
One of the most common symptoms of any type of sinusitis is pain, and the location depends on which sinus is affected.

  • If there is pain in the forehead, the problem lies in the frontal sinuses.
  • Pain in the upper jaw and teeth, with tender cheeks, may mean the maxillary sinuses are involved.
  • Pain experienced between the eyes, sometimes with swelling of the eyelids and tissues around the eyes, tenderness (when touched) on the sides of the nose may mean sinusitis has developed in the ethmoid sinuses.
  • Pain in the neck, ear, and top of the head could be a sign that the sphenoid sinuses are involved (though these sinuses are affected less often).

Most people with sinusitis have pain or tenderness in several places, and their symptoms usually do not clearly indicate which sinuses are inflamed. Pain is not as common in chronic sinusitis as it is in acute sinusitis.

In addition to the pain, people who have sinusitis (acute or chronic) often have thick nasal secretions that can be white, yellowish, greenish, or blood-tinged. Sometimes these secretions drain in the back of the throat and are difficult to clear. This is referred to as “post-nasal drip.” Also, cases of acute and chronic sinusitis are usually accompanied by a stuffy nose, as well as a general feeling of fullness over the entire face.

Less common symptoms of sinusitis (acute or chronic) can include the following:

  • Fatigue
  • Decreased sense of smell
  • Cough that may be worse at night
  • Sore throa
  • Bad breath
  • Fever

On very rare occasions, acute sinusitis can result in a brain infection and other serious complications.

Because the nose can get stuffy or congested when one has a condition like the common cold, simple nasal congestion can be confused with sinusitis. A cold usually lasts about 7 to 14 days and goes away without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than a cold.

Diagnosis
A healthcare professional usually can diagnose acute sinusitis by noting the symptoms and examining the nose and face. If the symptoms do not clearly indicate that sinusitis is present or if they persist for a long time and do not get better with treatment, the healthcare professional may order a CT (computerized tomography) scan (a form of X-ray that shows some soft-tissue and other structures that cannot be seen in conventional X-rays) to confirm that sinusitis is present.

Other laboratory tests a healthcare professional may use to check for possible causes of chronic rhinosinusitis include the following:

  • Blood tests to rule out conditions, such as an immune deficiency disorder, that are associated with sinusitis.
  • A sweat test or a blood test to rule out cystic fibrosis.
  • Tests on the material inside the sinuses to detect a bacterial or fungal infection.

Treatments:

After diagnosing sinusitis and identifying a possible cause, a healthcare professional can suggest various treatments.

Acute sinusitis
If acute sinusitis is diagnosed, a healthcare professional may recommend the following:

  • Antibiotics to control a bacterial infection, if present
  • Pain relievers
  • Decongestants (medicines that shrink the swollen membranes in the nose making it easier to breathe)

Even if one has acute sinusitis, a healthcare professional may choose not to treat it with an antibiotic because many cases of acute sinusitis will end on their own. However, if one does not feel better after a few days, contact a healthcare professional again.

Follow the healthcare professional's instruction on how to use an over-the-counter or prescribed decongestant nose drops and sprays. Use these medicines for only a few days. Long term use can lead to even more congestion and swelling of the nasal passages.

If one suffers from nasal allergies, such as hay fever, along with sinusitis, a healthcare professional may recommend medicine to control allergies. This may include a nasal steroid spray that reduces the swelling around the sinus passages and allows the sinuses to drain.

If one has asthma and then gets sinusitis, the asthma signs and symptoms may worsen. Contact a healthcare professional, who may change the asthma treatment.

Chronic sinusitis
Healthcare professionals often find it difficult to treat chronic sinusitis successfully. They have two options to offer patients: medicine and surgery.

Medicine

  • Nasal steroid sprays are helpful for many people, but most people still do not get full relief of symptoms with these medicines.
  • A long course of antibiotics is occasionally recommended by physicians, but results from clinical research do not support this kind of antibiotic use.
  • Saline (saltwater) washes or saline nasal sprays can be helpful in chronic sinusitis because they remove thick secretions and allow the sinuses to drain.
  • Oral steroids, such as prednisone, may be prescribed for severe chronic sinusitis. However, oral steroids are powerful medicines with significant side effects, and these medicines typically are prescribed when other medicines have failed.

Research is needed to develop new, more effective treatments.

Surgery
When medicine fails, surgery may be the only alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. Nasal surgery usually is performed to accomplish the following:

  • Enlarge the natural openings of the sinuses.
  • Remove nasal polyps.
  • Correct significant structural problems inside the nose and the sinuses if they contribute to obstruct the sinuses.

Most people have fewer symptoms and a better quality of life after surgery. However, problems can reoccur, sometimes even after a short period of time.

In children, problems can sometimes be eliminated by removing the adenoids. These gland-like tissues, located high in the throat behind and above the roof of the mouth, can obstruct the nasal passages.


 
 

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