Sinusitis is an inflammation of the nasal sinuses. Nasal sinuses are hollow cavities within the cheek bones found around and behind the nose. Researchers believe that the primary functions of these sinuses are to warm, moisten and filter the air in the nasal cavity. They also play a role in our ability to vocalize certain sounds.
Sinusitis may be acute or chronic, lasting for months or years if inadequately treated.
Sinusitis, which also can produce adverse effects on the nose, eyes, or middle ear, may be suggested by fever, cough, tiredness, a plugged up nose and bad tasting postnasal drip. Additional evidence is colored, thick nasal drainage, feelings of facial fullness, head congestion, headache and toothache.
These signs and symptoms vary depending on the severity of the infection and which sinuses are involved -- only a few signs or all may be present. You should consult your physician promptly if these symptoms develop.
CAUSES OF SINUSITIS
Usually, bacterial sinusitis occurs after an initial upper respiratory tract infection, or the common cold. Although colds are the most common cause of sinusitis, those with allergies are predisposed to the development of sinusitis. Immunologic problems or structural problems also may lead to chronic sinus infections.
Allergy can cause chronic inflammation of the sinus and nasal mucous lining. This inflammation prevents the usual clearance of bacteria from the sinus cavity, increasing the chances of developing secondary bacterial sinusitis. If you should test positive for allergies, your physician can prescribe appropriate medications to control them, thereby reducing the risk of developing an infection.
Allergists are physicians who specialize in treating all aspects of allergic disease, especially in designing effective avoidance measures to control the allergy and administering allergy shots (immunotherapy) to reduce sensitivity to environmental allergens. People with sinus problems (and allergies) should avoid environmental irritants such as tobacco, smoke and odors which may increase symptoms.
Immunologic problems are another possible cause of chronic sinusitis. Researchers have found that the ability of children with chronic sinusitis to respond to immunizations correlates with their ability to fight bacteria that cause sinusitis. More than half of the children with chronic sinusitis in the study had abnormalities in their immune systems. However, the results of this study may not be conclusive. More research needs to be conducted before we can understand the relationship between chronic sinusitis and abnormalities in the immune system.
Structural problems in the nasal cavity may be another cause of recurring sinusitis. Narrow drainage passages within the nose or nasal obstruction from tumors, polyps or a deviated nasal septum (wall between the left and right sides of the nose) are examples of structural problems. Although medications can often prevent recurring sinusitis, surgery is sometimes needed to remove the nasal obstruction. Many patients with recurring or chronic sinusitis have more than one of these factors that predispose them to infection, so addressing only one factor may not be sufficient.
Even if symptoms are localized to the sinuses, infection is not always present. To make a correct diagnosis, the physician will take a detailed history and conduct a physical examination. Tests also may be needed. These tests can include allergy skin testing, sinus x-ray, CT scans (which make precise images of the sinus cavities), and sampling of the nasal secretions or lining.
The physician also may perform an endoscopic examination. This is a narrow, flexible fiber-optic scope that is placed into the nasal cavity through the nostrils. It allows the physician to view the area where the sinuses and middle ear drain into the nose in an easy "patient friendly" manner.
Sinus infections generally require a combination of medications. In addition to an appropriate antibiotic, a medicine may be prescribed to keep the sinus drainage passages open by reducing obstruction and controlling allergy. This drainage-opening medicine may be a decongestant, mucus-thinning medicine or a cortisone-like nasal spray. Antihistamines, cromolyn and topical steroids (sprayed into the nose) help control allergy and inflammation.
Long-term treatment for controlling and reducing allergic sensitivity can be effective in preventing the development of sinusitis in people with allergies. This treatment may include immunotherapy, anti-inflammatory medications, decongestants, and environmental control measures. The preventative use of low dose antibiotics and sinus drainage medications during times of increased susceptibility, e.g. winter, also may prevent sinusitis from occurring.
A variety of non-medicine mechanical treatments can be of value. These include steam inhalations, increasing the intake of fluids, hot packs and the use of an over-the-counter sterile salt water spray. In some cases of obstructed sinus passages, a referral to an otolaryngologist (ENT) may be suggested.
SINUSITIS VS. RHINITIS
Although many symptoms are similar, sinusitis should not be mistaken for rhinitis. Rhinitis is an inflammation of the mucous membrane of the nose, not the paranasal sinuses. It is often caused by allergies, increased sensitivity to irritants (smoke, etc.), temperature changes, or the abuse of over-the-counter decognestant nasal sprays. Poorly controlled chronic or recurring rhinitis can lead to sinusitis.
Your allergist can provide you with more information on sinusitis and rhinitis.
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|Publication:||Pamphlet by: American Academy of Allergy and Immunology|
|Date:||Feb 1, 1993|
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