Sinusitis

Definition

Sinusitis is an inflammation of the sinuses, which are airspaces within the bones of the face. Sinusitis is most often due to an infection within these spaces.

Description

The sinuses are paired air pockets located within the bones of the face. There are:

• the frontal sinuses, located above the eyes, in the center region of each eyebrow
• the maxillary sinuses, located within the cheekbones, just to either side of the nose
• the ethmoid sinuses, located between the eyes, just behind the bridge of the nose
• the sphenoid sinuses, located just behind the ethmoid sinuses, and behind the eyes.

The sinuses are connected with the nose. They are lined with the same kind of skin found elsewhere within the respiratory tract. This skin has tiny little hairs projecting from it called cilia. The cilia beat constantly to help move the mucus produced in the sinuses into the respiratory tract. The beating cilia sweeping the mucus along the respiratory tract helps to clear the respiratory tract of any debris or of any organisms that may be present. When the lining of the sinuses is at all swollen, the swelling interferes with the normal flow of mucus. Trapped mucus can then fill the sinuses, causing an uncomfortable sensation of pressure and providing an excellent environment for the growth of infection-causing bacteria.

Demographics

It is estimated that about 37 million Americans are affected by sinusitis each year. Having a cold increases the chance of getting sinusitis. Immune system disorders also increase this likelihood. Children with asthma are also considered more likely to be affected by sinusitis.

Causes and symptoms

Sinusitis is usually due to an infection, although swelling from allergies can mimic the symptoms of pressure, pain , and congestion, and allergies can set the stage for a bacterial infection. Bacteria are the most common cause of sinus infection. Streptococcus pneumoniae causes about 33 percent of all cases, while Haemophilus influenzae causes about 25 percent of all cases. Sinusitis in children may be caused by Moraxella catarrhalis (20%). In people with weakened immune systems (including patients with diabetes, acquired immunodeficiency syndrome or AIDS , and patients who are taking medications that lower their immune resistance, such as cancer and transplant patients), sinusitis may be caused by fungi such as Aspergillus , Candida , or Mucorales .

Acute sinusitis usually follows some type of upper respiratory tract infection or cold. Instead of ending, the cold seems to linger on, with constant or even worsening congestion. Drainage from the nose often changes from a clear color to a thicker, yellowish-green. The individual may develop a fever . Headache and pain over the affected sinuses may occur, as well as a feeling of pressure that may worsen when the patient bends over. There may be pain in the jaw or teeth. Some children, in particular, get upset stomachs from the infected drainage going down the back of their throats and being swallowed. Some patients develop a cough .

Chronic sinusitis occurs when the problem has existed for at least three months. There is rarely a fever with chronic sinusitis. Sinus pain and pressure are frequent, as is nasal congestion. Because of the swelling in the sinuses, they may not be able to drain out the nose. Drainage, therefore, drips constantly down the back of the throat, resulting in a continuously sore throat and bad breath.

When to call the doctor

If the child is displaying the signs of sinusitis for more than a few days, the doctor should be contacted. If a cold seems to be getting better and then gets worse again, it may have developed into sinusitis. Likewise, colds that linger beyond a week may indicate sinusitis, and the doctor should be called.

Diagnosis

Diagnosis is sometimes tricky, because the symptoms so often resemble those of an uncomplicated cold. However, sinusitis should be strongly suspected when a cold lingers beyond about a week's time.

Medical practitioners have differing levels of trust in certain basic examinations commonly conducted in the office. For example, tapping over the sinuses may cause pain in patients with sinusitis, but it may not. A procedure called "sinus transillumination" may or may not also be helpful. Using a flashlight pressed up against the skin of the cheek, the practitioner will look in the patient's open mouth. When the sinuses are full of air (under normal conditions), the light will project through the sinus and will be visible on the roof of the mouth as a lit-up, reddened area. When the sinuses are full of mucus, the light will be stopped. While this simple test can be helpful, it is certainly not a perfect way to diagnose or rule out the diagnosis of sinusitis.

X-ray pictures and CT scans of the sinuses are helpful for both acute and chronic sinusitis. People with chronic sinusitis should also be checked for allergies, and they may need a procedure called nasal endoscopy where a very slender lighted fiber optic tube is placed in the nose in order for the doctor to see if any kind of anatomic obstruction is causing the illness. For example, the septum (the cartilage which separates the two nasal cavities from each other) may be slightly displaced (a deviated septum). This condition can result in chronic obstruction, setting the person up for the development of an infection.

Treatment

Antibiotic medications are used to treat acute sinusitis. Suitable antibiotics include sulfa drugs, amoxicillin, and a variety of cephalosporins. These medications are usually given for about two weeks but may be given for even longer periods. Decongestants or the short-term use of decongestant nose sprays can be useful. Acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) can decrease the pain and headache associated with sinusitis. Also, running a humidifier can prevent mucus within the nasal passages from drying out uncomfortably and can help soothe any accompanying sore throat or cough.

Chronic sinusitis is often treated initially with antibiotics. Steroid nasal sprays may be used to decrease swelling in the nasal passages. If an anatomic reason is found for chronic sinusitis, it may need to be corrected with surgery. If a surgical procedure is necessary, samples are usually taken at the same time to allow identification of any organisms present which may be causing infection.

Fungal sinusitis requires surgery to clean out the sinuses. Then, a relatively long course of a very strong antifungal medication called amphotericin B is given through a needle in the vein (intravenously).

Alternative treatment

Some practitioners believe that chronic sinusitis is associated with food allergies . These doctors would suggest an elimination/challenge diet to identify and eliminate allergenic foods. While linking chronic sinusitis to food is widely considered controversial, many practitioners link the problem to aero-allergies. Irrigating the sinuses with a salt-water solution is thus recommended for sinusitis and allergies, in order to clear the nasal passages of mucus. Another solution for nasal lavage (washing) uses powdered goldenseal ( Hydrastis canadensis ). Other herbal treatments, taken internally, include a mixture made of eyebright ( Euphrasia officinalis ), goldenseal, yarrow ( Achillea millefolium ), and horseradish, or, when infection is present, a mixture made of echinacea ( Echinacea spp.), wild indigo, and poke root ( Phytolacca decandra-Americana ).

Homeopathic practitioners find a number of remedies useful for treating sinusitis. Among those they recommend are: Arsenicum album , Kalium bichromium , Nux vomica , Mercurius iodatus , and Silica .

Acupuncture has been used to treat sinusitis, as have a variety of dietary supplements, including vitamins A, C, and E, and the mineral zinc. Contrast hydrotherapy (hot and cold compresses, alternating three minutes hot, 30 seconds cold, repeated three times always ending

with cold) applied directly over the sinuses can relieve pressure and enhance healing. A direct inhalation of essential oils (two drops of oil to two cups of water) using thyme, rosemary, and lavender can help open the sinuses and kill bacteria that cause infection.

Prognosis

Prognosis for sinus infections is usually excellent, although some individuals may find that they are particularly prone to contracting such infections after a cold. Fungal sinusitis, however, has a relatively high death rate.

Prevention

Prevention involves the usual standards of good hygiene to cut down on the number of colds an individual catches. Avoiding exposure to cigarette smoke, identifying and treating allergies, and avoiding deep dives in swimming pools may help prevent sinus infections. During the winter, it is a good idea to use a humidifier. Humidifiers should be adequately and frequently cleaned with bleach or comparable cleanser to avoid mold which can be aerosolized and then exacerbate existing allergies. Dry nasal passages may crack, allowing bacteria to enter. When allergies are diagnosed, a number of nasal sprays are available to assist in preventing inflammation within the nasal passageways, thus allowing the normal flow of mucus.

Parental concerns

Sinusitis can usually be treated successfully with antibiotics. It can, however, be very dangerous or even fatal if left untreated it becomes progressively worse such that the infection spreads.

See also Allergic rhinitis .

Resources

BOOKS

Bruce, Debra Fulghum, et al. The Sinus Cure: 7 Steps to Relieve Sinusitis and Other Ear, Nose, and Throat Conditions. Westminster, MD: Ballantine Books, 2001.

Chronic Sinusitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet Sources. San Diego, CA: Icon Group International, 2004.

Hirsch, Alan R. What Your Doctor May Not Tell You about Sinusitis: Relieve Your Symptoms and Identify the Source of Your Pain. Boston, MA: Warner Books, 2004.

Kavuru, Mani S., et al. Diagnosis and Management of Rhinitis and Sinusitis , 2nd ed. Cleveland, OH: Professional Communications, 2001.

Kenned, David W., et al. Living with Chronic Sinusitis: A Patient's Guide to Sinusitis, Nasal Allergies, Polyps, and Their Treatment Options. Long Island City, NY: Hatherleigh Co., 2004.

Plasse, Harvey, et al. Sinusitis Relief. New York: Henry Holt & Co., 2002.

PERIODICALS

Glaser, Gabrielle. "How to Spot a Sinus Infection." Parents Magazine 75 (March 2000): 89–93.

ORGANIZATIONS

American Academy of Allergy, Asthma and Immunology. 611 East Wells Street, Milwaukee, WI 53202. Web site: http://www.aaaai.org.

American Academy of Otolaryngology-Head and Neck Surgery Inc. One Prince Street, Alexandria, VA 22314–3357. Web site: http://www.entnet.org.

Joint Council of Allergy, Asthma, and Immunology. 50 N. Brockway, Suite 3.3, Palatine, IL 60067. Web site: http://www.jcaai.org.

WEB SITES

"Sinusitis." National Institute of Allergy and Infectious Diseases , April 2002. Available online at http://www.niad.nih.gov/factsheets/sinusitis.htm (accessed November 15, 2004).

Helen Davidson Rosalyn Carson-DeWitt, MD