Sinusitis can be acute or chronic. It’s one of the most common reasons to see a doctor. The treatment may be pharmacological in acute form or surgical in chronic form.
What are the sinuses?
The lateral sinuses or paranasal sinuses are air-filled spaces located within the bones of the skull. These spaces occur in young children as diverticula of the mucous membrane sinking into the bones, they grow and aerate with age. In children some sinuses may not be present at all (e.g. frontal sinuses), they develop later with the child’s growth. The . Some sinuses continue to grow and develop even into late adulthood, and they are fully developed at the age of 20.Well-built sinuses are aerated, which means that they are filled with air and not with fluid. The presence of the fluid indicates disease. The sinuses can be of different sizes. The largest ones are called the maxillary, frontal and sphenoid sinuses. Many small cells above the nasal passages are collectively called the ethmoid sinuses.
What is sinusitis?
The lateral sinuses are connected with the nasal passages, that’s why nasal infections, runny nose, upper respiratory tract infections can easily spread into the sinuses. When the mucous membrane lining the sinus from the inside is inflamed , an inflammatory exudate appears , which can turn into a purulent discharge. The duct of the sinus into the nasal cavity is often swollen, that’s why the discharge is blocked inside it. It causes pain and feeling of pressure .
- Acute sinusitis is a complication of an acute upper respiratory tract infection. If not treated properly, it can turn into chronic sinusitis, which symptoms persist over 12 weeks.
- Symptoms in an acute form include fever, a purulent nasal discharge, a throbbing pain and pressure in the sinus area.
- Symptoms in a chronic form first of all include a chronic purulent nasal discharge, impaired nasal breathing and olfactory disorders.
Causes of sinusitis
A lot of factors, both inside and outside the body, influence the formation of acute and consequently chronic sinusitis. Allergy in a significant way predisposes to sinusitis, because of the upper respiratory tract mucosa swelling, which causes the paranasal sinuses blockage and the development of the disease .
Sinusitis is also caused by a very common dysfunction such as nasal septum deviation.
Symptoms of acute sinusitis
Symptoms of acute sinusitis include among others: a purulent nasal discharge, impaired nasal patency, pain and pressure in the sinus area and fever. Acute sinusitis is often accompanied by constant runny nose. Sometimes there is also a toothache.
Symptoms of chronic sinusitis
Symptoms of chronic sinusitis are less characteristic, they include among others a purulent nasal discharge, impaired nasal breathing, olfactory disorders, cough, nosebleeds, chronic sore throat, malaise and fatigue.
- You should see a doctor when, from the patient’s point of view, the course of the cold is untypical, when there appear alarming symptoms not seen before, such as: pain in the sinus area, forehead or occiput, which is very strong and pulsating and it intensifies in a certain position of the body (e.g. when you lean forward). Also when a high body temperature persists or even increases.
- Urgent medical assistance is necessary, when acute upper respiratory infection is accompanied by shortness of breath, severe ear pain , a purulent ear discharge, hearing loss, dizziness, impaired consciousness and other symptoms indicating disease progression. Special attention should be paid to young children, in whom the infection develops very fast and leads to common symptoms, dehydration and convulsions.
How to recognize sinusitis?
The lateral sinuses are not seen in a standard nasal examination. At most you can assess their ducts and the presence of a purulent discharge in nasal passages, which indicates an inflammatory process. They also cannot be thoroughly assessed by performing a standard sinus X-ray.
In acute sinusitis combined with catarrhal, viral and bacterial infections the doctor makes a diagnosis based on the medical history , nasal cavity and sinus ducts endoscopy.
In chronic sinusitis the doctor should perform a radiological examination (CT scan), thanks to which we can determine the size of inflammatory changes in individual sinuses, assess the presence of other factors, which cause chronic inflammation, such as nasal septum deviation or hypertrophy of the pharyngeal tonsil and determine indications for surgical treatment.
Treatment of acute sinusitis involves administration of the appropriate antibiotics, mucosal decongestants, mucus thinners , anti-inflammatory and antipyretic drugs. The necessity to include an antibiotic and conduct therapy should be controlled by the doctor.
Surgical treatment is often the best approach in case of chronic sinusitis. . In case of recurrent acute sinusitis (e.g. several times a year), you can suppose that there is a reason that causes it. Thanks to additional tests, including CT scan, we can identify the reason and treat it properly. A classic example is nasal septum deviation, hypertrophy of the pharyngeal tonsil or anatomical differences in the lateral wall of the nose.
Complications of sinusitis
The sinuses are located close to the eye socket and brain tissue, separated from them only by a thin bone lamella. It also happens, that among completely healthy people on a limited area, there is no bone barrier separating the brain from the sinus, there is only the layer of the meninges. Therefore an infection developing in the sinuses can also spread to these structures. Sinusitis can cause serious complications. Orbital cellulitis with an abscess or exophthalmos may occur, which may result in blindness or visual disturbances. Brain tissue also may become infected with the formation of an abscess and meningitis can occur. Sepsis, or blood poisoning with the risk of death may also occur.
Important: complications of sinusitis can be life-threatening!