Sinusitis - you don’t have to put up with the discomfort

• It is rarely triggered by fungal infections, even though this is becoming more common in those who have HIV and diabetes

Sinusitis is an inflammation of the lining of the paranasal sinuses. The sinuses are paired hollow structures in the skull, located behind the forehead, behind the cheeks, and behind the eyes.

The sinuses are usually covered by a mucous layer and contain hairs that propel bacteria and dirt outwards towards the nasal cavity.

Causes

Sinusitis, or rhino-sinusitis as it is commonly known, may be acute or chronic.

It is considered acute when it lasts less than eight weeks or occurs no more than three times a year.

Chronic or recurrent sinusitis lasts longer than eight weeks and occurs more than four times a year.

Acute sinusitis usually follows a common cold or flu, and is mainly viral, but some allergens may also trigger an acute infection.

The lining of the sinuses and the nasal cavity will usually thicken with infection, and block the nasal passage. This blockage encourages the growth of bacteria, which begin to multiply, invading the lining of both the sinuses and nasal passages. Viral sinusitis typically lasts 7 to 10 days, whereas bacterial sinusitis lasts longer. Very rarely will sinusitis result from fungal infections, but this is becoming more common with HIV and diabetes.

Symptoms

Symptoms of rhino-sinusitis depend on the particular sinuses that are affected, and whether the infection is acute or chronic.

Acute sinusitis mainly presents with a runny and congested nose, mucus dripping down the throat, sometimes accompanied by a sore throat, cough, pressure, fullness and pain between the eyes, severe persistent headaches that are worse when bending, and are located on the forehead, between the eyes, or behind the eyes, fever, and pain around the cheek bones.

Chronic sinusitis will usually present with a persistent nasal discharge, obstruction, a persistent sore throat, bad breathe, and a persistent post nasal drip. It may also present with thick, yellow nasal discharge, reduced sense of smell, and in some patients, dental infections.

Though sinusitis is a clinical diagnosis made on a proper history and exam, it can occasionally be confused for a simple common cold, flu or upper respiratory tract infection. It therefore requires a high index of suspicion by the clinician, though most experienced clinicians will usually make the diagnosis easily based on a thorough history and physical exam.

Some additional tests may however be done to confirm the diagnosis, and these will usually be done in chronic infections which are recurrent, and require to establish exactly which sinuses are involved. These tests include X-rays, CT and MRI scans of the paranasal sinuses.

Treatment

Conservative treatment of sinusitis is considered for viral sinusitis, and mainly involves taking plenty of water and other hot fluids, as well as steam inhalation to promote drainage of the nasal mucus.

Pain killers may be administered for associated headaches, while decongestants and nasal saline irrigation may be used to thin the mucus. Antibiotics are necessary to clear the infection in both acute and chronic bacterial infections but unnecessary for viral sinusitis. Surgery on the other hand is considered for chronic sinusitis.

About 40 per cent of all acute sinusitis resolves on its own without the need for any treatment (mainly because it is viral), however treatment with antibiotics will resolve bacterial sinusitis promptly.