Sinusitis
Symptoms
Sinusitis is the inflammation of the sinuses, which are air cavities located in the skull and connected to the nasal cavity. Inflammation is usually caused by a common cold, flu or hay fever and is characterised by severe swelling of the nasal mucosa and increased mucus production. The sinuses constantly produce mucus, which helps to moisten the nose and trap harmful substances from the inhaled air.
Swelling in the sinuses can block the drainage passages, causing pain in the facial area, primarily below or between the eyes and the forehead. If this condition is not treated promptly, the secretions can become purulent, greenish-yellow, and thick, leading to sinusitis.
Apart from the common cold, flu and hay fever, other factors that can lead to sinusitis are anatomical abnormalities of the nose such as a crooked septum and nasal polyps. In these cases, the nasal abnormality prevents the free flow of secretions, causing them to accumulate and cause sinus fever. Also, inflammation of the teeth in the upper jaw, dental procedures, additional facial fractures and marine activities such as scuba diving can also cause sinusitis.
The most common microbes associated with sinusitis are Streptococcus, Pneumococcus, Staphylococcus, Haemophilus, Moraxella, and various anaerobic bacteria.
Diagnosis
A detailed patient history plays a crucial role in diagnosis. Most patients complain of headaches, a feeling of heaviness, and facial pain that worsens when bending over, weakness, fatigue, fever, altered sense of smell, nasal congestion and discharge, cough, bad breath, and dental discomfort.
The exact diagnosis is made by endoscopy, which is a detailed examination of the nose with a flexible or rigid endoscope up to the nasopharynx. The orifices of the sinuses are checked, whether or not they are obstructed, the presence of purulent secretions and any other pathology or anatomical problem that may cause or maintain the condition are checked. The examination is short, painless and the patient can breathe and speak normally. It has no radiation and therefore can be performed on pregnant women and children.
Facial radiography has been abandoned as a method because the information it provides is not accurate and does not help in its diagnosis, since a cloudy image in the sinus area can also appear in a common cold or rhinitis.
CT scans are mainly used when endoscopic examinations reveal anatomical abnormalities of the nose, such as nasal polyps. In this case, the extent of the damage can be assessed and its role in sinusitis determined. CT scans are also useful in diagnosing and further managing sinusitis complications.
Treatment
Treatment primarily depends on accurate diagnosis. Acute sinusitis is mainly treated with broad-spectrum antibiotics, nasal mucosal decongestants, and regular nasal rinses, which patients can be trained to perform at home using saline or hypertonic solutions
If symptoms persist for a long time chronic sinusitis may have developed. In such cases, treatment may include endoscopic surgery to clean and open the sinus openings.
