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Sinusitis

schematic diagram displaying various para nasal sinuses. maxillary, ethmoid, sphenoid, frontal. also shows how they appear when they have sinusitis - inflamed sinuses

What exactly is a sinus?

 First of all, there are four pairs of sinuses in our head. Sinuses are hollow, air-filled and interconnected spaces located around the nose in the skull. All these spaces or cavities open into the nose through tiny openings called ostia. As both sinuses and nose are lined with the same soft tissue called mucosa, any infection that affects one affects the other too.

First, let’s get to the individual pairs of sinuses. As we stated earlier, there are four pairs in all. These are:

1. Frontal sinus (in forehead)

2. Maxillary sinus (behind cheeks)

3. Ethmoid sinus (between eyes)

4. Sphenoid sinus (deep behind the ethmoids) 

It is rather surprising but there is no clear consensus on the primary function of sinuses in our bodies. Some of their accepted functions are relative weight reduction of the front part of skull (remember, sinuses are hollow and filled with air), air-conditioning and humidification of air that’s breathed in, giving added resonance to voice, and lending mechanical rigidity.

What is sinusitis?

Sinuses are lined by a soft tissue called mucosa. When this mucosa gets infected, the resulting condition is called sinusitis. Actually it is more appropriate to term it as rhino-sinusitis (rhino- is a suffix used for nose in medical science) as infection of nose and sinuses go hand in hand. 

The mucosa that lines both nose and sinuses produces secretions which are carried to the back of the nose through the openings called ostia. From nose, these move to the throat and then are swallowed to go into the gut.  Aiding this drainage movement in the correct direction are small hair-like structures called the cilia.  However, if this drainage system is disturbed due to some infection or some structural issues, secretions get accumulated and provide fertile ground for bacteria to grow and cause sinusitis.

What causes sinusitis?

Sinus infections can result from anything disrupting:

  1. Airflow into the sinuses
  2. Mucous drainage out of  the sinuses

When common colds, or allergies or similar conditions strike, the lining of sinuses as well adjacent nasal passage can become swollen to block the ostia, the tiny openings of sinuses that open up into the nasal cavity. Not just infections, sinuses can also get blocked by tumours, growths or structural abnormalities lying close to the sinus openings.

Sometimes mucous drainage also gets hindered due to thickening of these secretions which can happen due to reduced water content in the mucous which in turn could be due to some underlying disease such as cystic fibrosis, or due to drying medications like antihistamines or anti-allergic drugs, or simply because the air being breathed in lacks sufficient humidity and is too dry. Another reason could be damaged cilia (tiny hair-like structures that direct the flow of mucous out of sinuses) on the epithelial lining of these sinus cavities that could be damaged by irritants such as smoke. When damaged, cilia’s ability to move mucous in the right direction weakens and it gets accumulated in sinuses.

When mucous goes stagnant in sinuses, it becomes a rich, thriving and fertile habitat for growth of bacteria and viruses, and sometimes for fungus as well (e.g. in AIDS patients or in immunocompromised individuals).  In some cases, even these microbes can cause or worsen sinus blockage.

The maxillary and ethmoid sinuses suffer from infection more than other sinuses.

Are there various types of sinusitis?

Yes, sinusitis can be classified based on how long the problem has existed – acute, sub-acute, or chronic –  and whether is infectious or non-infectious in nature.

Here is a look at the major sinusitis types:

  • Acute sinus infection  - Present for less than 30 days, this is also called as  acute sinusitis due to infection, or acute bacterial rhinosinusitis
  • Sub-acute sinus -  An infection present for over 1 month but less than 3 months
  • Chronic sinus infection - An infection that has been present for more than 3 months.

Chronic sinusitis can be further categorized into chronic sinusitis with or without nasal polyps, or allergic fungal sinusitis.

We must tell you that there is no cut and dried medical consensus on the time limits of these various types of sinusitis infections.

What symptoms and signs will indicate that I might be suffering from sinusitis?

Most patients with sinus infection will usually show some of the following symptoms:

  • Stuffy nose
  • Obstructed nose
  • Cough
  • Headache
  • Recurring throat pain
  • Feeling of pain or pressure in face
  • Pain in ear and/or teeth
  • Weakened sense of smell
  • Trickling sensation/ irritation in the throat
  • Recurring urge to clear the throat

How does the ENT physician diagnose sinusitis?

First of all, the ENT physician will take your case history. He will also check the nasal cavity to seek signs of swelling or redness, gathered pus and hindered drainage along the mucosal lining of the nasal passages. Your ENT physician has limited visualization capacity as the sinuses and the nose go deep into the head but from the outside, your doctor can only see a part of it using the head light examination. To get a complete status, the doctor can recommend endoscopic examination of nose along with CT scans of nose and paranasal sinuses.

How will the ENT physician treat my sinusitis?

An ENT physician will prescribe medical treatment for acute sinusitis. However, chronic or recurrent sinusitis types need proper investigation to find out what’s causing them in the first place. In some cases, the treatment prescribed may involve an endoscopic procedure called FESS or functional endoscopic sinus surgery.

We strongly recommend that you do not attempt self-medication. Especially steer clear of topical nasal decongestant drops such as Otrivin and Nasivion that could lead to a tough to treat condition known as rhinitis medicamentosa on overuse.

What if I do not get my sinusitis treated? What could happen in that case?

Well, if you do not seek sinusitis treatment, you are in for a lot of discomfort and pain. Then if there are other health problems like asthma, things will go further downhill for your overall health. In rare cases, not getting sinusitis treatment could end up getting you bone infection, meningitis or brain abscess. All very serious conditions, mind you!

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