Sinusitis

What are sinuses?

Sinuses are hollow air spaces within the skull. They are located around the nose. There are four pairs of sinuses in the head. They include:

•Frontal sinuses over the eyes in the brow area

•Maxillary sinuses inside each cheekbone, and below the eyes

•Ethmoid sinuses just behind the bridge of the nose and between the eyes

•Sphenoid sinuses behind the ethmoids in the back of the nose and behind the eyes.

 

What is sinusitis?

Each sinus has an opening into the nose for the free exchange and drainage of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling of the lining of the nose be it an infection, an allergic reaction, or a structural abnormality can also affect the sinuses. Blockage of the normal sinus drainage pathway gives rise to build up of mucus, pus, and air trapping within the sinus, with associated inflammation and infection of the sinuses. This is what is termed sinusitis.

Acute sinusitis is usually short lived, and commonly follows a cold. The symptoms (outlined below) are often quite severe, and may be associated with fever, and rarely swelling of the face. Acute sinusitis commonly responds to medical treatment.

Chronic sinusitis as its name suggests continues for weeks, and the symptoms are usually not as severe as seen in acute sinusitis. It may have been preceded by an acute sinusitis, or it may be secondary to a chronic nasal condition such as allergy or a structural abnormality. It often responds to medical treatment, but in refractory cases endoscopic sinus surgery can be performed to open up the sinus openings into the nose to aid their drainage.

Untreated sinusitis can lead to complications with infection spreading to nearby structures, most importantly the eye and to the brain.

What are the symptoms of sinusitis?

Symptoms of sinusitis include:

 Nasal blockageRunny noseCatarrh or thick mucus secretionsPainAltered sense of smellUnpleasant smelling Breath (halitosis)

How do I know if I have sinusitis?

If you have symptoms suggestive of sinusitis then you should consult your doctor. Having taken a history, the diagnosis can usually confirmed by examination of the inside of the nose with an endoscope. This is a simple outpatient procedure, which allows clear visualisation of the sinus openings within the nose, as well as the rest of the nasal cavity.

In the primary care setting, where an endoscope may not be available, your doctor is often able to make the diagnosis based on the history, and treat you accordingly.

What is the treatment for sinusitis?

Medical Treatment

Acute sinusitis usually responds to medical treatment in the form of short course of nasal decongestants and antibiotics.

Chronic sinusitis also usually responds to medical treatment. The various options that may be utilised include antibiotics, nasal douching, nasal decongestants (short course only), steroid medication (tablets or nasal sprays), and antihistamines in those with underlying allergy.

Surgical Treatment

If medical treatment fails then surgery is usually indicated. The more modern approach to sinus surgery is with the use of an endoscope through the nose. This is termed endoscopic sinus surgery. This avoids the need for any cuts on the face. Prior to having your surgery your surgeon will arrange for you to have a CT scan of your sinuses. This will act as anatomical road map for the surgeon when he is performing your surgery.