Sinusitis

Sinusitis (sinus infection) is a common medical condition that occurs when the sinus cavities in the upper skull become inflamed and do not drain properly. When the sinuses accumulate fluid and mucus due to an allergy or upper respiratory illness, their passages become obstructed. Without proper drainage, the impacted material becomes a fertile area for viruses, bacteria, or occasionally fungi to grow and create infection. Sinus inflammation causes pain and thickened mucus within the nasal cavity and may be chronic or acute.

Causes of Sinusitis

The sinuses may become inflamed for a variety of reasons. A cold or respiratory infection is the most common reason for sinusitis to develop. Additional causes include:

Ear, nose and throat allergies
Nasal polyps
Deviated septum
Blockage of drainage ducts
Anatomical malformations of the nose or sinuses
Smoking or exposure to secondhand smoke

Individuals with immune deficiencies, or those who take medications that suppress their immune systems, are at greater risk for sinusitis.

Types of Sinusitis

Sinusitis is categorized by the location of the inflammation and duration of the infection. Sinusitis can occur in any of the four pairs of sinus cavities, all of which are named for their locations.

Maxillary, under the eyes, behind the cheeks
Frontal, in the frontal bone of the forehead
Ethmoid, between the nose and eyes
Sphenoid, in the sphenoid bone, at the center of the pituitary gland

Sinusitis is also classified according to the duration of the infection.

Acute sinusitis lasts up to 4 weeks
Subacute sinusitis lasts between 4 and 12 weeks
Chronic sinusitis persists for more than 12 weeks
Recurrent sinusitis occurs as several acute attacks within 1 year

Treatment for sinusitis may vary based on the type of sinusitis that the individual is suffering from.

Symptoms of Sinusitis

Symptoms of sinusitis are uncomfortable and may be very painful and disabling. These symptoms may include:

Congestion and nasal obstruction
Pain in the upper teeth
Mouth breathing
Yellow or green mucus discharge
Ear Pain
Bad breath
Fever
Visual disturbance

Sinusitis may also cause headaches, facial pain and pressure.

Diagnosis of Sinusitis

Sinusitis is diagnosed through a review of symptoms and a physical examination. An examination of the nose and throat is often necessary, usually with the aid of a lighted instrument called an endoscope. A nasal endoscopy may be performed to provide the doctor with a more thorough visualization of the area. The endoscope is inserted through the nose to illuminate the sinus cavities.

Nasal secretions may also be sampled for laboratory cultures to determine which particular germ is responsible for the patient's illness. If allergies are suspected as the cause of the inflammation, allergy testing may also be performed.

Treatment of Sinusitis

For acute or subacute sinusitis, the following treatment may be recommended:

Decongestants
Over-the-counter pain medication
Saline nasal spray
Nasal corticosteroids

If the infection is caused by allergies, antihistamines or allergy shots may be recommended. Antibiotics are prescribed if the sinusitis is caused by a bacterial infection. In rare cases, if the infection is caused by a fungus, anti-fungal medication is administered. Cases of chronic or recurrent sinusitis that have not responded to medication, may require surgery to enlarge the openings that drain the sinuses, remove nasal polyps or correct structural problems inside the nose and sinuses. These surgeries may include:

Functional endoscopic sinus surgery (FESS)
Image-guided surgery
Caldwell-Luc procedure
Septoplasty
Polypectomy

While most patients who have sinus surgery find relief from troubling sinus symptoms, a small percentage of individuals may continue to have episodes of sinusitis.