Sinusitis: A Public but Throbbing Condition

Abstract

This article reviews one of the common disorders of human body – Sinus. It is a very common symptom and not lethal. However, it could be very painful if left untreated. We have discussed some major information points about sinusitis viz the causes, symptoms, diagnosis, prevention, treatment, types and varieties, etc.

Keywords

Sinusitis, Sinus disorders, Rhinosinusitis

Introduction

The inflammation of the sinuses, which leads to some symptoms, is termed as Sinusitis. It is also commonly known as a sinus infection or Rhinosinusitis. If the condition persists less than a month, it will be termed as Rhinosinusitis; or if it lasts more than 3 months, it is termed as chronic Rhinosinusitis. A thick nasal mucous, plugged nose along with and pain in the face are the common symptoms of sinusitis. There may be some other symptoms as well such as fever, headaches, sore throat, cough, etc. The cough at night becomes sometimes excessive; however serious complications are unlikely [1-8].

Types

The common types of sinusitis can be classified in several categories. Broadly it can classified as on the basis of:

• Condition

• Location

On the basis of condition it can divided as:

• Acute rhinosinusitis: The common type which occurs through a new infection that may last up to a month and can be subdivided symptomatically into severe and non-severe [9-13].

• Recurrent acute rhinosinusitis: Four or more separate occurrences of acute sinusitis within a year [11,14-18].

• Subacute rhinosinusitis: The infection that lasts for 1-3 months, and represents a transition stage between acute and chronic infection [11,19-24].

• Chronic rhinosinusitis: Here, the symptoms lasts for more than 3 months [11,25-29].

• Acute exacerbation of chronic rhinosinusitis: When the signs and symptoms of chronic rhinosinusitis become huge but become returns to normal eventually [11,30-34].

On the basis of location it can be divided as:

• Maxillary: It leads to pain and pressure in the maxillary area [35,36].

• Frontal: They cause pain or pressure in the frontal sinus cavity in the forehead above the eyes [35,37].

• Ethmoidal: They cause pain or pressure between or behind the eyes, the sides of the upper part of the nose [35,38,39].

• Sphenoidal: It can cause pain or pressure behind the eyes, but often refers to the skull vertex (top of the head), or the back of the head [35,40].

Context

Causes

The common causes of sinusitis can be infection, allergies, air pollution, a structural problem in the nose or the most common would be a viral infection. If the symptoms last more than ten days or the condition worsens after starting to improve may suggest a bacterial infection. The people suffering with asthma, cystic fibrosis and poor immune function are also very prone to sinusitis. If high complications are suspected, then an X-ray is required [41-46]. When the condition becomes chronic, a confirmatory testing is recommended by either direct visualization or computed tomography. Apart from that conventional radiology techniques and modern technology may be indicated. Their indication is based on the clinical context [47-50].

Smoking can also be a major cause along with dental problems, given the proximity of teeth and sinus wall. The occurrence may be due to some abnormalities as well within the auditory or eustachian tube, which are connected to the sinus cavities and the throat. The eustachian tube is almost in level with the eye sockets but the abnormality occurs due to hereditary information, and hence becomes lower than the eye socket level, sometimes even in level with the vestibule or nasal entrance [13,51-55].

Symptoms

The main symptoms include Facial pain or pressure, Nasal stuffiness, Nasal discharge, Loss of smell, Cough or congestion, Fever, Bad breath, Fatigue, Dental pain, green or yellow nasal discharge [34,56,57]. If the symptoms persist for 8 weeks, it could be a Chronic Sinusitis. The symptoms of Chronic Rhinosinusitis include: the face will have a Congestion feeling or fullness, Nasal obstruction, Nasal cavity pus, Fever, Nasal discharge or discoloured postnasal drainage. Apart from this the symptoms may be present as Headaches, Bad breath, Fatigue, Dental pain, Chronic Sinusitis [41,58-63].

Diagnosis

The diagnosis of Sinusitis is made the Doctor through a physical examination mostly. However, sometime other tests are also needed [64,65]. The physical tests include the pressing of sinuses to check the tenderness; by tapping the teeth to check whether the patient has inflamed paranasal sinus [66].

Prevention and Treatment

In some cases the condition can be prevented by hand washing, quitting or avoiding smoking and immunization. Pain killers such as naproxen, nasal steroids, and nasal irrigation can be applied to keep the symptoms in check. Treatment with an antibiotic may lead to some bacterial cases. Although even after seven days, there is still no improvement, then antibiotics can either be recommended or changed. The patients on whom the antibiotics are applied, either amoxicillin or amoxicillin/clavulanate is recommended. Surgery can be used occasionally for chronic cases [67-71]. The treatment options for nearly all types of sinusitis includes Nasal Endoscopy. It is a tube like instrument on which tiny lights and cameras are mounted. The surgeons or doctors use it to see inside the nose and sinus drainage areas. The process might require anaesthesia although not always [71-74]. Even though treatments of treatment of sinusitis are more or less same, some treatments depend on particular cases, such as:

Acute sinusitis

Doctors recommend decongestant medicines and steam inhalations for a simple sinus infection. However, these medicines should not be used more than a couple of days as it might lead to increase in congestion. In case of antibiotics, a 10-14 days course will see the symptoms disappear [75-78].

Chronic sinusitis

Inhalation of mild heated steam can ease the pain in nose and sinuses. Apart from this, saline nose drops can be used as well at home. Nasal drops, sprays are recommended but not for longer periods, the prescribed antibiotics and steroids are also possible [79-82].

Allergies

In case of allergies and fungus, antihistamine and antifungal drugs can be prescribed. The immunoglobulin antibodies can also be prescribed in case of any immune deficiencies [83-86].

Miscellaneous

The factors which trigger sinusitis should be avoided and the nasal sprays, nose drops or decongestant medicine can be prescribed for decongestion [87-90].

Surgery

Sometimes, surgeries are necessary for sinusitis when there is a structural in sinuses or have nasal polyps which are blocking the drainage and most importantly if antibiotics and other medicines are not working.

Endoscopy

Before the surgery the doctor usually explain the whole process of the surgery to the patient and the surgery mostly comprises of an endoscope to do these operations. The normal time to recover might take 5-7 days and the whole recovery might take 1.5 months [91-93].

Turbinectomy

Sometimes, doctors use Turbinectomy to shrink the swollen tissues of nose within a few minutes [94-96].

Balloon sinusplasty

It is similar to balloon angioplasty. The unblocked sinus can drain mucus more freely after it has been opened up swollen, inflamed sinuses using balloon sinuplasty [97-99].

Conclusion

The different types of sinusitis have different conditions; however to begin with, they have similar symptoms, thus they are often difficult to distinguish. Acute sinusitis is very common among all other types. Almost 90% of adults have had sinusitis at some point in their life. Every year as a common disease sinusitis affects 10-30% of people in USA & Europe. It is found that women are more prone compared to men. Chronic sinusitis affects approximately 12.5% of people. The treatment of sinusitis in the United States results in more than 11 billion USD in costs [100].

If sinusitis is left untreated, it can cause pain and discomfort and sometimes it can also form meningitis or a brain abscess and an infection of the bone.

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