What are the sinuses?Behind the bones of your face there are some hollow spaces, filled with air, which lead to the nose cavity - they are what we know as the sinuses. Your sinuses have the same mucous membrane lining as your nose does. The membrane produces a slimy secretion (mucus), keeping the nasal passages moist. The mucus traps dirt particles and germs.
There are four main sets of sinuses, they are all paired.
- In each cheekbone
THE MAXILLARY SINUSES
These are the largest sinuses, also the ones that most commonly are affected when a person has sinusitis.
- Above your eyes, either side of your forehead
THE FRONTAL SINUSES
- Behind the bridge of your nose, between your eyes
Can also be broken down into anterior and posterior - front and back
- Between the upper part of your nose an behind your eyes
What is sinusitis?Sinusitis is an inflammation of the paranasal sinuses. Paranasal means adjacent to the naval cavities. The inflammation could be caused by an infection from a virus, bacteria or fungus. It may also be the result of an allergic or autoimmune reaction. An autoimmune reaction is when your immune system attacks the good parts of your body.
Doctors often refer to sinusitis as rhinosinusitis, because an inflammation of the sinuses nearly always occurs with inflammation of the nose (rhinitis).
Sinusitis can also be referred to the cavity is affects:
- Maxillary sinusitis - the patient feels pain or pressure in the cheek (maxillary) area. This can be experienced as toothache or headache.
- Frontal sinusitis - the patient feels pain and/or pressure behind or above the eyes (frontal sinus cavity). The pain will generally be experienced as headache.
- Ethmoid sinusitis - the patient feels pain and/or pressure behind or between the eyes. Usually as in the form of a headache.
- Sphenoid sinusitis - the patient usually feels pain or pressure in the top part (vertex) of the head.
How long does sinusitis last?
- Acute sinusitis - lasts up to a maximum of 4 weeks.
Acute sinusitis is often caused by the common cold. However, it could be caused by bacteria, allergies, or a fungal infection. Treatment depends on what caused it. In the majority of cases home remedies are suitable treatments. However, if the sinusitis is persistent it can lead to serious infections and complications.
Typically, with acute sinusitis, the patient's sinuses become inflamed and swollen. This stops the drainage and causes a build up of mucus. Doctors may refer to this as acute rhinosinusitis.
If you have acute sinusitis may find it hard to breathe through your nose. The area adjacent to your eyes and nose may feel swollen and puffed up. You could also have throbbing facial pain and a headache. Sometimes a patient with acute sinusitis may have a fever. Treatment may include an antibiotic.
- Subacute sinusitis - lasts from 4 to 12 weeks
This type of sinusitis represents a continuation of the natural progression of acute sinusitis that has not got better. Symptoms will be pretty much the same as with acute sinusitis, possibly less severe, but treatment may be different. Treatment may include an antibiotic.
- Chronic sinusitis - Lasts at least 12 weeks, or keeps coming back.
Chronic sinusitis is usually caused by an infection. However, it can also be caused by nasal polyps (growths in the sinuses), as well as a deviated septum.
As with acute and subacute sinusitis the sinuses become inflamed and swollen, causing blockage and mucus build up. Doctors often refer to this as chronic rhinosinusitis. The patient may find it hard to breathe through his nose. He may experience throbbing facial pain and a headache.
At onset it is very hard for a doctor to know which one a patient is likely to have as the symptoms are very similar.
What are the signs and symptoms of sinusitis?Acute Sinusitis signs and symptoms
If the patient has two or more of these symptoms, and/or thick, green or yellow nasal discharge he may be diagnosed with acute sinusitis.
- Facial pain and pressure
- Blocked nose
- Nasal discharge
- Poor sense of smell
- Cough These symptoms may also be present
- A high temperature
- Halitosis (bad breath)
The following signs and symptoms may have been present for at least 8 weeks
- Congested, puffy face
- Blocked nose
- Nasal cavity has pus
- A high temperature (fever)
- Nasal discharge
- Discolored postnasal drainage
- These symptoms may also be present
- Halitosis (bad breath)
What are the treatments for sinusitis?In the majority of cases sinusitis will resolve itself without treatment. Many patients find that home treatments provide some relief. These treatments include some OTC (over-the-counter) medications.
- Steam inhalation - you breath in steam from a bowl of hot water - not boiling. The water may have some drops of menthol oil. Although patients do feel they experience some relief, this treatment has not been scientifically proven. Standing or sitting in a very steamy shower may sometimes provide the same effect.
- Nasal Irrigation - this is also known as sinus irrigation, sinus rinse, or sinus lavage. It is a home procedure that involves a salt water rinse to clear the nasal passages.
- Warm compress - if you apply a warm compress gently to the affected areas of your face you may have some relief of symptoms.
- Sleeping with your head raised - when you go to bed prop up some pillows so your head is higher than it usually is. This may reduce the amount of pressure around the sinuses and lower the discomfort and pain.
- Painkillers - if you take a painkiller that you would normally have to treat a headache, your fever may improve.
- Decongestant tablets - these may reduce swelling and allow the sinuses to drain.
- Decongestant sprays - these may have the same effect as tablets. However, do not use them for more than a week. The risk of making the blockage worse rises if you use decongestant sprays for prolonged periods. Ask your doctor or pharmacist for advice.
- Antibiotics - a review of clinical trials found that while antibiotics can provide small improvements in uncomplicated sinusitis cases, most patients recover without the drugs within two weeks. However, in patients with severe symptoms, like high fever, severe pain in cheeks and swelling of face, antibiotic treatment is justified. The most commonly prescribed antibiotics for sinusitis are:
- Beta-Lactams - these include penicillins, such as Amoxicillin (Amoxil,
Polymox, Trimox, Wymox (or any generic formulations). These antibiotics
work by interfering with the bacterial cell walls. As drug resistance
grows, many of these types of medications have lost some of their
effectiveness. Make sure you are not allergic to penicillins if you are
prescribed these. Cephalosporins are also beta-lactams, and may include
first generation (Keflex), cefadroxil (Duricef, Ultracef), and
cephradine (Velosef), second generation cefaclor (Ceclor), cefuroxime (Ceftin), cefprozil (Cefzil), and loracarbef (Lorabid), and third generation cefpodoxime (Vantin), cefdinir (Omnicef) cefditoren (Sprectracef), cefixime (Suprax), and ceftibuten (Cedex). Ceftriaxone (Rocephin). These are effective against a wide range of bacteria.
If you are allergic to penicillin you may find cefpodoxime, cefdinir, and cefuroxime are effective for mild to moderate sinusitis.
- Macrolides and Azalides - these antibiotics attack the
bacteria genetically. They are sometimes used with patients with mild to
moderate symptoms who are allergic to penicillin. Included are such
drugs as erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), and roxithromycin (Rulid). These drugs are not effective against H. influenzae.
These drugs also have anti-inflammatory properties, which might help patients with chronic sinusitis.
- Trimethoprim-Sulfamethoxazole - these are also useful alternatives to patients who are allergic to penicillin. Certain streptococcal strains, however, have developed resistance to these types of drugs. Allergic reactions can be severe. They should not be given to patients who have had infections after dental work.
- Fluoroquinolones (Quinolones) - these medications stop the bacteria from reproducing. Levofloxacin (Levaquin), sparfloxacin (Zagam), gatifloxacin (Tequin), and moxifloxacin (Avelox) are extremely effective against the common bacteria that cause sinusitis. They are commonly used to treat patients who have already taken antibiotics within six weeks. They are also commonly prescribed for patients who are allergic to beta-lactams.
- Lincosamide - also stops the bacteria from reproducing. Effective against S. pneumonia but not H. influenza.
- Tetracyclines - these drugs help stem the spread of bacteria, and include doxycycline, tetracycline, and minocycline. Patients may have side effects which include skin sensitivity to sunlight, sore throat sensation, and tooth discoloration.
- Ketolides - effective against antibiotic-resistant bacterial strains.