Sinusitis refers to the inflammation and swelling of the sinuses. Sinuses are cavities found in the bones of our face. There are four sinuses and are located around the nasal passages. These cavities communicate with the nasal passage via four narrow openings.  These openings drain the mucus secreted in the sinuses which are normally filled with air.  When these opening are blocked, sinuses gets filled up with mucus and debris which subsequently gets infected with microorganisms and cause sinusitis.

Most of the time the inflammation is caused by a viral upper respiratory tract infection and resolves within 3-4 weeks.  It is called acute sinusitis. Not infrequently, the communicating openings do not open completely that creates environment for a chronic inflammation. This is called chronic sinusitis.  

Causes

Number of infectious and noninfectious etiologies can cause sinusitis. Some are discussed below:

Infectious causes of sinusitis:

• Viral infection (common cold):  most common cause of acute sinusitis.
• Bacterial infection: when common cold doesn’t resolve in 10 days, it is usually caused by a bacteria.
• Fungal infection: more common in immunocompromised patients. Causes chronic sinusitis.
• Tooth infection: infection of root of upper teeth can spill into the sinuses causing sinusitis.

Non infectious causes include:

• Allergic rhinitis.
• Polyps and tumors of the sinus and nose
• Deviated nasal septum.
• Cystic fibrosis can cause sinusitis through impaired mucus clearance.
• In the hospital setting, insertion of tubes into the nose and respiratory passage to aid ventilation increases the risk factor of sinusitis.

Symptoms

Common symptoms of sinusitis include:

• Nasal discharge: especially thick, yellow, green discharge.
• Blocked nose that makes breathing through the nose uncomfortable.
• Headache, earache.
• Facial pain and tenderness around cheekbones.
• Cough and postnasal discharge that is worse at night.
• Loss of smell and taste.

You may also have fever, bad breath and jaw pain from sinusitis.

Diagnosis

Sinusitis is diagnosed based on the symptoms and examination of nose, oral cavity and pressure application over cheekbones. Most of the time, no further testing or imaging is required. In complicated and refractory cases, your doctor may send you for an allergy testing, or perform nasal endoscopy, bacterial and fungal culture of the nasal secretion, or order a CT scan of your sinuses.

Treatment

Treatment of sinusitis depends on whether the infection is acute or chronic:

Acute sinusitis: Most patients with acute sinusitis improve without antibiotic therapy. If the symptoms are mild to moderate and of less than 10 days in duration, therapy is aimed at facilitating the drainage of the blocked sinuses by the use of nasal decongestants, nasal flush with normal saline and nasal steroids. A vaporizer or steam inhalation may also help in draining the blocked sinuses. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use.

Use of nonprescription decongestant nasal drops or sprays are effective in controlling symptoms. However, they should not be used beyond their recommended duration of use.  If the patients do not improve after 10 days or if they are suffering from severe symptoms, antibiotic therapy is recommended. Antibiotics are typically given for a period of 10 to 14 days. Pain killers can be used to control headaches.

Chronic sinusitis:  In chronic sinusitis, the treatment is guided towards control of underlying condition which is most likely an allergy. Avoidance of allergens, chronic treatment with antihistamines and nasal corticosteroids are the mainstay treatment options. Sometimes immunotherapy (allergy shots) is required to control allergy. Surgery can be done to correct a deviated septum or remove nasal polyps.