Definition

     Sinusitis refers to inflammation of the sinuses. This is generally caused by a viral, bacterial, or fungal infection.

Causes

• Predisposing:
   

1. Viral Rhinitis (cold)

2. Allergies

3. Nasoseptal deformity

4. Large adenoids

5. Cleft palate

6. Choanal atresia

7. Intranasal foreign body

8. Cystic Fibrosis

9. Immunodeficiency

10. Diving, flying

11. Dental problems

12. Nasal Polyps

1. Streptococcus pneumoniae

2. Haemophilus Influenza

3. Moxarella catarrhalis

4. Staphylococcus aureus

Symptoms

     The classic symptoms of acute sinusitis usually follow a cold that does not improve, or one that worsens after 5 - 7 days of symptoms. They include:

• Nasal congestion and discharge

• Sore throat and postnasal drip (fluid dripping down the back of your throat, especially at night or when you lie down)

• Headache -- pressure-like pain, pain behind the eyes, toothache, or facial tenderness

• Cough, often worse at night

• Fever (may be present)

• Bad breath or loss of smell

• Fatigue and generally not feeling well

     Symptoms of chronic sinusitis are the same as acute sinusitis, but tend to be milder and last longer than 8 weeks.

Screening and Diagnostics

• Trans-illumination (passing light through the sinuses) may show fluid collection; this is not helpful for patients younger than 10 years of age.

• Sinus X-Rays show mucosal thickening, air-fluid level, complete opacification

• CAT scan of sinuses (more accurate than X-Rays)

• Cultures are not helpful unless done by needle inserted into the sinuses (only done in extreme cases)

Treatment

• Oral antibiotics usually 10 to 14 days. Commonly used antibiotics include Ceftin and Augmentin.

• Older antibiotics such as amoxicillin and erythromycin may be prescribed, but you should be aware they do not provide as broad a coverage as the Ceftin and Augmentin. Specifically, they are not as effective against Haemophilus Influenza.

• Oral decongestants, such as pseudoephedrine, and nasal sprays, such as Afrin, for the first 3 days may be helpful (after 3 days "rebound" may occur and the decongestants may no longer be effective).

• Take a warm shower twice a day, and "blow out excessive mucous."

• Saline nasal sprays may be used multiple times during the day to loosen nasal secretions.

• Chronic Sinusitis: Treatment lasts 3-6 weeks.

Prognosis

     Sinus infections are usually curable with self-care measures and medical treatment. If you are having recurrent attacks, you should be checked for underlying causes such as nasal polyps or other problems.

Complications 

     Although very rare, complications that may arise include:

• Osteomyelitis -- infection that spreads to the bones in the face

• Meningitis -- infection that spreads to the brain

• Orbital cellulitis -- infection that spreads to the area surrounding the eye

• Abscess

• Blood clot

• The bacteria causing your sinusitis may develop resistance to antibiotics used to treat the infection, which makes it more difficult to find the best treatment

Prevention 

     The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

• Get an influenza vaccine each year.

• Wash your hands frequently, particularly after shaking hands with others.

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.

• Reduce stress.

     Additional tips for preventing sinusitis:

• Avoid smoke and pollutants.

• Use a humidifier to increase moisture in your nose and sinuses.

• Drink plenty of fluids to increase moisture within your body.

• Take decongestants during an upper respiratory infection.

• Treat allergies promptly and appropriately.