Inflammation of the mucous membranes within the paranasal sinuses is called sinusitis or rhinosinusitis, which could be due to infection, allergy or autoimmune problems. This is a very common condition and is mostly caused by viruses.
There are several pairs of sinus cavities which, when inflamed, typically result in different symptoms based on their locations. Maxillary sinus inflammation leads to cheek-, tooth- or headaches. Frontal sinuses usually cause forehead pain; Ethmoidal sinus inflammation typically creates pain between the eyes or either side of the nose. And lastly, the sphenoidal sinuses can cause symptoms behind the eyes but usually result in pain below the ears or on the top or the back of the head.
The condition can be acute (new infection up to 4 weeks), recurrent-acute (4 or more separate episodes within a year), sub-acute (duration between 4 and 12 weeks) or chronic (symptoms last longer than 12 weeks and may include episodes of acute exacerbation) but, the symptoms are all very similar and it is often difficult to distinguish between classifications.
Acute sinusitis mostly follows a viral URTI (upper respiratory tract infection) but bacteria may be the culprits. There is also the possibility of a viral URTI leaving the body vulnerable to secondary bacterial infections of the sinuses. The viral infections tend to clear up within 7-10 days while the bacterial infections generally last longer. Fungal infections occur mainly in patients with a compromised immune defense ( diabetes, AIDS, transplant patients) and such infections could be life threatening. Chemical irritation can trigger an acute episode and rarely, it may result from a tooth infection.
Chronic sinusitis if often linked to asthma and caused by a variety of diseases, all sharing the common symptom of sinus inflammation. Symptoms may include congestion; headaches; facial pain; night-coughing; aggravated asthma; fatigue; thick, green/yellow nasal discharge; dizziness and aching teeth, all of which usually worsen with tipping the head forward. Chronic sinusitis may furthermore result in bad breath, a reduced sense of smell/taste and dental infections. It is important to consider other origins for these symptoms rather than simply assuming sinusitis.
Considering the multifactorial nature of chronic sinusitis, the management approach has shifted away from attempts to treat infections, rather to the management and reduction of the inflammation which in turn minimizes obstruction and infections. Patients may however still need antibiotics initially to clear away bacterial infections.
The signs and symptoms of sinusitis include localized headaches/facial pain/pressure as mentioned above and will often start on one side before spreading across. The tooth ache, thick nasal discharge, post-nasal drip and a productive cough are elements which distinguish a sinus headache from the others. Sinus infections can also cause inner ear problems and eye or bone infections which may present with severe illness and fever.
Predisposing factors to developing sinusitis include structural abnormalities of the sinuses or the Eustachian tube(s), changes in pressure e.g. during flights, allergies or exposure to air pollutants or chlorinated pool water, and prior bouts of sinusitis, as each instance of inflammation may further narrow the passages. Smoking and second hand smoke are both associated with chronic sinusitis. Lastly, the inflammation in a maxillary sinus may result from an odontogenic (tooth) infection and may continue to spread to the orbit (eye socket) and the ethmoid sinus. Dry air will aggravate the condition no matter what the initial cause was.
Diagnosis of sinusitis rarely includes imaging (x-ray/CT/MRI) unless complications have already developed. Classically the increased pain/pressure when tipping the head is the most important detail. In the case where sinusitis has been present for more than 12 weeks (chronic), a CT scan is advisable. The clinical symptoms, a nasal endoscope and, possibly, tissue samples or a sinusoscope are used to make a positive diagnosis. People with asthma or nasal polyps commonly have AFS (allergic fungal sinusitis).
Physiotherapy can assist in acute and especially in chronic sinusitis through means of reducing the inflammation in the linings, reducing the viscosity of the secretions and aiding in clearing the passages by increasing the rate of drainage from the sinus cavities. Other forms of conservative treatments that patients can use at home, to complement their physio sessions, include nasal irrigation, decongestant sprays (careful of rebound-sinusitis!) and inhaling low temperature steam a few times a day. Intranasal corticosteroid use has also proven to be beneficial. and surgery should only be considered as a last resort.
Sinus vs Bronchitis vs The common cold:
Sinusitis typically lasts for longer than 10 days, teeth hurt, head movements are painful, a fever may be present and the productive cough is mainly a bother at night and early mornings.
Bronchitis has a more consistent cough throughout the day.
The common cold usually starts off with clear, runny secretions for 3 days followed by a stuffy nose for 3 days before, barring a secondary bacterial infection, clearing up.
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