Blame it on Your Sinus

You think it is flu or cold.

You swallow one or two over-the-counter [OTC] pills, or visit your physician/therapist who gives you appropriate medications. The symptoms regress. Soon after, there is persistent heaviness in the head, or headache, nasal blockage and/or thick nasal discharge. You drag yourself to an ENT specialist who after evaluating your symptoms, followed by examination, and possibly X-ray, or CT scan, of the sinuses, tells you that you have sinusitis.

Sinusitis, in simple terms, means an infection or inflammation of the sinuses. The disorder can be broadly classified into two forms or types depending on the duration of symptoms:

• Acute: Up to four weeks
• Chronic: More than eight weeks [sometimes, several months, or even years].

What are sinuses

Sinuses are hollow air-filled cavities in the skull bone, situated around the nose. Hence, the term “para-nasal sinuses.” Each sinus has an opening in the nasal cavity that helps in the ventilation and drainage of mucous secretions. The sinuses also have a lining/membrane that is in link with the nose. There are tiny hair-like cells [cilia] in this lining that moves, to and fro, to drain out the mucous.

There are primarily four sinuses –

• Frontal: above the eyes [forehead]
• Maxillary: on either side of the nose [cheek]
• Ethmoidal: behind the bridge of the nose; in-between the eyes
• Sphenoid: Above and behind the nose.

Acute sinusitis

Anything that causes swelling of the sinus lining, or prevents the cilia from moving the mucous, can cause sinusitis. Most cases of acute sinusitis start as common cold — usually caused by a virus. This predisposes the patient to develop sinus infection as the lining of the sinus swells, leading to air and mucous being trapped behind the narrow/blocked openings of the sinuses. This provides the perfect soil for the invasion and multiplication of bacteria. Most healthy people harbour bacteria in their upper respiratory tracks with no problems until the body’s defences are weakened.

Allergy attacks, irritation from environmental pollutants, changes in temperature or air pressure, excessive usage of nasal decongestant drops/sprays, and smoking, predispose acute sinusitis.

Chronic sinusitis

Some experts think that chronic sinusitis is an infectious disease, while others debate about it being an allergic condition. Individuals with asthma or allergies – including air-borne allergens like house-dust mites, mould or pollen – are prone to chronic sinusitis. Some people who are allergic to fungi may develop “allergic fungal sinusitis.” People who have had acute sinusitis and are inadequately treated with antibiotics, or other therapies, may eventually develop chronic sinusitis.

Infection from the throat, dental area [upper teeth], and trauma to the sinuses can also cause chronic sinusitis. Poor living conditions, obstruction to sinuses due to deviation of the nasal partition [septum], nasal allergies, small growths [polyps] and tumours, including asthma, are other predisposing factors.

Symptoms

Acute sinusitis is rapid in its onset. It is characterised by headache, or pain over the sinus region.

• Aching, redness and swelling of the cheek spreading to the lower eyelid [maxillary sinus]
• Swelling of the upper eyelid [frontal sinus]
• Marked swelling of the eyelids and area above and towards the root of the nose [ethmoid sinuses].

Touching any of these areas on examination is quite painful to the patient. Other symptoms include fever, nasal blockage, and yellowish/greenish coloured, thick discharge from the nose. In chronic sinusitis the severity of the symptoms is less but they last for a longer period. The predominant symptom is headache, followed by –

• Maxillary: pain on the cheek, aching in upper jaw and teeth
• Frontal: Pain over the forehead, when you wake up in the morning; this gets aggravated when you bend
• Ethmoid: Pain on the bridge of nose, between the eyes, which is increased by eye movements
• Sphenoid: Pain at the top of the head, earache, and pain in the neck.

Symptoms also include nasal blockage, nasal discharge, and discharge traversing from the back of the nose into the throat [post-nasal drip], diminished sense of smell, fever, tiredness, and cough [may be worse at night]. Some people with post-nasal drip may have secondary infection of the ear, or the throat [dryness/soreness of throat].

Diagnosis and management

One often goes to an ENT specialist saying that they have a “sinus problem,” when, in fact, they may just have a common cold, or allergy – with nasal congestion being the common symptom. The common cold typically lasts for 7-14 days. It usually disappears even if treatment is not taken. Sinusitis, however, lasts longer and has a plethora of symptoms than mere nasal congestion.

If symptoms are vague and persist despite medical treatment, a CT scan is done. In the olden days, X-ray of the sinuses was done to diagnose sinusitis. With progress in imaging technology, CT scan has become the investigation of choice for sinusitis. The CT scan not only helps in diagnosing sinusitis, but it also gives information about which sinuses are involved, the severity and extent of the disease, including variations in the structure of the sinuses. This helps the ENT surgeon to be wary while performing sinus surgery and also minimise complications, if any.

Acute sinusitis is treated by antibiotics, decongestant tablets and nose drops [to reduce the swelling of the nasal lining and sinus openings], anti-inflammatory and pain-killer tablets, and steam inhalation [10 minutes after instilling nose drops, 2-3 times a day; the ventilation of the sinuses improves after nasal decongestion]. Most patients of acute sinusitis respond well to medical therapy and rarely require surgery.

When medical treatment fails, or if your CT scan reveals extensive chronic sinusitis, surgery may be necessary.