Sinusitis

Sinusitis (Rhinosinusitis) is the inflammation of the lining membrane of any one or more of the four sets of paranasal sinuses, which include the frontal, ethmoid, maxillary and sphenoid sinuses. The inflammation may or may not be the result of infection from fungal, bacterial, viral, allergic or autoimmune issues.

How many kinds of sinusitis are there?

Sinusitis is subdivided into the classifications of: acute sinusitis, with symptoms lasting greater than three weeks, sub-acute sinusitis, with symptoms lasting three weeks to three months and chronic sinusitis, with symptoms lasting greater than three months.

It is estimated by the National Institute of Allergy and Infectious Diseases that more than 37 million Americans are affected by some degree of sinusitis every year.

What are the symptoms of sinusitis?

There are many symptoms related to sinusitis, typically the symptoms of sinusitis include: sinus congestion, sinus discharge, sinus pressure, facial pain, and headaches.

Anatomical Causes

Anatomical causes for sinusitis include:

Deviated Septum:
A deviated septum is crookedness of the cartilage inside the nose. Approximately 80% of the population has some degree of septal deviation. For some individuals, the degree of deviance in severe enough to block nasal drainage and affect normal breathing. A deviated septum can typically be surgically corrected with a procedure called a septoplasty.

Abnormal Turbinates:
There are three bony structures inside of the nose called turbinates (superior, middle, and inferior). Turbinates function as a surface area to warm and humidify air that passes through the nasal passages. Swelling of these structures due to infection or allergies can cause nasal blockage. Turbinates can be removed in a surgical procedure called a turbinectomy.

Concha Bullosa:
Concha Bullosa (CB) is a common anatomical disorder that occurs when a bubble or air pocket develops on the middle turbinate. Concha Bullosa are typically associated with deviated septums and are surgically corrected with a procedure called endoscopic sinus surgery.

Nasal Polyps:
Nasal Polyps are small saccule like growths caused by inflamed tissue lining the nose. Nasal polyps are one of the most common lesions of the nasal cavity and occur more often in middle-aged men.

Because deviated septums, abnormal turbinates, concha bullosa, and nasal polyps each cause blockage of the nasal pathways, they all affect normal clearing of the sinuses which result in the individual experiencing this condition being more prone to sinus infection.

Lifestyle Causes

Water Exposure:
Bacterial sinusitis can be acquired by exposure to or swimming in polluted water. Even chlorinated water can increase the risk of sinusitis as it reduces the movement of microscopic cilia (hairs) that line the interior of the sinuses and nasal passage. The use of nose plugs can help reduce

Pregnancy / Hormonal changes:
It is common during pregnancy, for many women to experience “rhinitis of pregnancy”, which is an inflammation of the nasal lining that blocks mucus drainage. The condition is the result of natural hormonal changes that occur during the months of pregnancy. Some women also experience this disorder when taking birth control pills.

Exposure to Children:
Adults who have continual exposure to children such as parents, family members and teachers are susceptible to repeated episodes of colds and bacterial sinus infections. This is because children are likely to carry bacteria that have developed resistance to antibiotics. Adults who catch such an infection may not respond to first-line antibiotics.

Inflammatory and Infectious Causes

Allergies:
Seasonal allergic sinusitis can occur when airborne particles such as pollen, animal dander, mold spores etc. come into contact with the inner lining of the nose, eyes or throat. The allergic reaction causes an inflammatory

Viral Infection:
A viral infection or upper respiratory infection (URI) is the most common cause of sinusitis and may be caused by hundreds of various strains of viruses.

Bacterial Infection:
Acute sinusitis is typically bacterial in origin. In adults Haemophilus Influenzae and Streptococcus pneumonia are the organisms that are most responsible for sinusitis, while in children similar organisms are seen but can also include Moraxella catarrhalis, Candida, Aspergillus and Phycomycetes.

Fungal infections:
Fungal infections are caused by plant like organisms and have two subsets:

Allergic Fungal Sinusitis (AFS):
AFS is an allergic reaction to aerosolized environmental fungi, causing mucus and debris that may require surgical removal or the use of nasal steroids.

Invasive Fungal Rhinosinusitis (IFR):
Fungal infections of the sinuses are thought to be the majority cause of chronic sinusitis treatment is dependent on the type of fungal infection that is present.

Acid Reflux:
Gastric acid produced in the stomach creeping back up to the esophagus causing heartburn may damage structures other than just the esophagus, resulting in a number of health problems including sinus infections and eroded teeth and gums.

Developmental Causes

Cystic Fibrosis:
Cystic Fibrosis (CF) is a non-contagious disease caused by an inherited genetic defect. About 1 in 23 Americans carries at least one defective gene for the disease making it the most common genetic defect in the United States. CF typically affects both the nose and the sinuses.

Tumors

Tumors that develop in the sinuses are a rare cause of sinusitis which can cause obstructions within the nasal passages.

What types of prevention can be done?

  • Sinusitis can often be deterred by taking some of the following precautionary measures:
  • Treat nasal congestion caused by colds or allergies immediately, this can assist in the prevention of a bacterial infection;
  • Avoid contact with individuals with colds or other URI’s, if you do have exposure to an individual(s) with URI it is imperative to wash hands often;
  • Avoid cigarette, cigar and pipe smoke in the home and in the workplace;
  • Avoid environments that trigger allergy attacks such as being around pets, dust, or dander;
  • Consider using a humidifier at home or work to increase the moisture in the air.

What are the complications of sinusitis?

Sinusitis, when properly managed, rarely has complications. However, untreated sinusitis can become problematic due to the close proximity of the nasal passages to the brain and the eyes. In some circumstances, sinus infections can travel to other regions of the head and cause life-threatening infections. Some of the complications that may occur due to unresolved chronic sinusitis include:

Intracranial Complication:

The frontal, ethmoid and sphenoid sinuses are separated from the cavity surrounding the brain by a layer of bone, if the infection passes through the bone it may infect tissue and cause fluid that lines the brain causing meningitis. In more severe cases, the infection can spread to the brain itself causing even more severe complications.

Orbital Complications:

The frontal, maxillary, ethmoid and sphenoid sinuses rest immediately above, below, between and behind the eyes. Untreated sinus infections may spread to the orbital region of the eye causing a wide spectrum of complications from mild inflammation of the eyelid to abscesses that can affect vision.

Vascular Complications:

The carotid artery and cavernous sinus are two large vascular structures that border the sphenoid sinus. Infections that occur within these regions may lead to complications of the blood vessels including blood clots or aneurysms;

Asthma:

Many patients suffer simultaneously from both chronic sinusitis and asthma, in many instances resolving the sinus issue results in a dramatic improvement of the asthma;

Loss of Smell and Taste:

Sinusitis can affect the senses of smell and taste, which may be temporary or permanent depending on the nature of the sinusitis.

What are the symptoms for children?

Many of the symptoms of childhood sinusitis are similar to those of the common cold. When symptoms last longer than seven-to-ten days there is a possibility that the child may have sinusitis. The common symptoms of childhood sinusitis include:

  • Fever;
  • Yellow or green nasal drainage;
  • Cough;
  • Headache;
  • Facial pain or pressure;
  • Congestion;
  • Swelling around the eyes; and
  • Chronic sneezing.

What is the treatment for sinusitis?

A specialized professional, preferably an otolaryngologist with extensive sinus experience, is necessary to evaluate and diagnose the causes of chronic or acute sinusitis. It is important to not only deal with the current bout of sinusitis, but to take steps to reduce the chances of the sinusitis recurring in the future, which require analysis of the likely contributing factors.

The sinus-specialty otolaryngologists of The Sinus Institute at CEI have over 35 years of experience treating sinusitis in all of its forms using both medical treatments and cutting edge surgery options. Click here to make an appointment.