Sinusitis

There are several types of sinusitis based on the severity of inflammation, history of the individual, and the duration of symptoms. It is classified into the following categories:

• Acute Rhinosinusitis (ARS)
  It is a condition when you experience sinusitis for a maximum of four weeks and can be classified as severe ARS and non-severe ARS depending on the symptoms. It can also be subdivided on the basis of organism causing the infection as viral rhinosinusitis and acute bacterial rhinosinusitis.
• Recurrent Acute Rhinosinusitis (RARS)
  Sinusitis is said to be recurrent if there are four or more episodes of acute sinusitis within one year.
• Subacute Rhinosinusitis (SARS)
  It is a transition phase from ARS to chronic rhinosinusitis (CRS). It lasts for 4 to 12 weeks.
• Chronic Rhinosinusitis (CRS)
  It is the inflammation of the sinus lasting for more than 12 weeks. It can be further subdivided depending on the inflammatory patterns as CRS in the presence of nasal polyps and CRS in the absence of nasal polyps. Nasal polyps are painless soft outgrowths that cause difficulty in breathing due to a blocked nose.
• Acute Exacerbation
  It is a condition in which the CRS worsens and shows symptoms and severity similar to that of acute rhinosinusitis.

All types of sinusitis show similar signs and symptoms. Individuals with CRS generally have symptoms of lesser severity but have pain in the facial muscles, bad breath, disturbances in the sense of smell, cough, and constant irritation in the throat.

The most frequently observed symptoms in individuals with sinusitis are as follows:

• Fever.
• A cough, which worsens at night.
• Frontal (forehead) headache.
• Pain in the teeth.
• Nasal congestion.
• White, yellow or green discharge from the nose.
• Decreased sense of taste and smell.
• Tenderness and swelling on various parts of the eyes, nose, cheeks, and forehead.
• Bad breath.

Other symptoms of sinusitis include:

• Nausea.
• A feeling of extreme exhaustion or fatigue.
• Moderate to severe discomfort in the chest.
• A decrease in or loss of appetite.
• Pain in the upper jaw. (Read more - Jaw pain causes and treatment)
• Ear pain.

Sinusitis is often confused with rhinitis, which is a condition involving only the nasal passages. It causes symptoms, such as nasal irritation and inflammation, runny nose, fatigue, and nasal obstruction. It could also be caused due to allergies or cold.

(Get online doctor consultation for any health issue)

Causes

Sinusitis occurs due to the following reasons:

• Cold.
• Infections.
• Irritation in the nasal cavity and the lining of the sinus, e.g., exposure to an excessively chlorinated water in swimming pools.
• A sinus infection may block the ostia. Microbial growth occurs in the trapped mucus in the sinuses. Viruses are the most common cause of sinus infections. Bacteria and fungi may also cause sinusitis. Individuals with a weak immune system (body’s defence system) are more prone to this condition and may suffer from viral and bacterial sinusitis.

Risk factors

The individuals with the following conditions and habits are more susceptible to have sinusitis:

• Active or Passive Cigarette Smoking
  Smoking, as well as exposure to smoke, increases the risk of sinusitis.
• Structural Abnormalities 
  Polyps, a deviated nasal septum, facial bone deformities like cleft palate, tumours of the nose, narrowed sinus openings and more such conditions also make a person prone to developing sinusitis.
• Medical Conditions
  • Recurrent allergies, such as hay fever, asthma, and cold.
  • Dental conditions like an untreated tooth or gum abscess.
  • Chronic illnesses, including diabetes, cystic fibrosis, and HIV infection.
• Certain Medications
  Regular and prolonged use of medications, such as nasal decongestants.
• Gender
  Women are more prone to sinusitis than men.
• Environmental Factors
  • High altitudes.
  • Air pollution.

Sinusitis can be prevented by taking care of a few things, such as:

• Irrigate nasal passages regularly
  Run water through the nasal passages using a squeeze bottle. This will help in clearing the nasal passage and prevent sinusitis.
• Avoid dry environments
  A humidifier at your residence or workplace can help in preventing dryness of the air you breathe and help keep your nasal passages moist.
• Drink plenty of water
  It helps in flushing out toxins from the body and prevents infections.
• Exercise regularly
  Indulging in any physical activity such as running, jogging, yoga, exercise and others increase blood circulation throughout the body and help in strengthening the immunity.
• Eat a healthy diet
  Having a balanced diet rich in fruits and vegetables helps in improving the defence mechanism of the body and fighting infections.

The following tests are performed to detect sinusitis:

• Allergy Testing
  This is a test conducted to identify the cause of sinusitis. IgE (a type of antibody or protein of the immune system) levels are measured using a blood test and a scratch test in which small amounts of allergens are pricked into the skin, might be done to identify the substance(s) you are allergic to.
• Nasal Endoscopy
  It is performed by doctors in severe cases to examine your sinuses and nasal passages to look for mechanical obstruction that might be causing the symptoms.
• Imaging Tests
  Imaging tests such as X-ray of the sinuses, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) Scan may also be done. These are performed to determine any physical abnormalities, such as polyps, deviated septum, narrowed drainage passages, which lead to the symptoms.

The appropriate treatment for sinusitis is essential to living a good quality life. The following are the treatment methods for sinusitis:

• Antihistaminic drugs
  They help in treating the symptoms of allergic reactions. They prevent the inflammation of the sinuses and nasal cavity.
• Nasal decongestant spray
  They can be useful if used for a short duration of three to four days. They help in draining the accumulated fluid from the sinuses. However, their long-term use may cause dependency in which the nasal passages will get blocked due to swelling and mucus if the decongestant is not used.
• Nasal saline irrigations
  Wash your nasal passage using distilled or saline water and clear off the thick mucus secretions.
• Topical nasal corticosteroids
  These are prescribed to treat the inflammation. The normal dose of these drugs can be used for an extended period without any side effects or addiction.
• Antibiotics
  This is not a commonly used therapy for sinusitis because 98% of the acute sinusitis infections are due to viruses. Antibiotics are the primary mode of treatment for bacterial sinus infections. They do not provide relief from the symptoms necessitating other over the counter medications along with antibiotic treatment. As antibiotic resistance has increased, antibiotics are generally prescribed when the symptoms persist for more than 7 to 10 days.
• Surgery
  It is the last treatment option when all medications have failed. It is generally needed in the cases of bony defects and is performed by an otolaryngologist. Surgery can help correct errors in the nasal septum, remove nasal polyps, and open the blocked passages. It can be performed under local as well as general anaesthesia depending on the condition.

Lifestyle management

Even if you are undergoing therapy, self-care is essential for completely resolving sinusitis. The following are the steps to be incorporated in your daily routine for a complete cure:

• Take plenty of rest
  Resting up adequately will help in faster recovery and getting back to your normal daily routine.
• Keep your body hydrated
  Drink plenty of fluids, which will help in keeping your mucus thin.
• Avoid smoking
  Staying away from smoking will prevent further irritation and dehydration of the nasal and sinus lining and help in a speedy recovery.
• Inhale Steam
  Stay in a hot shower for a prolonged period or inhale the steam of steaming hot water from a utensil. Bend on top of the utensil while sitting on a chair or ground and placing the utensil before you. Cover your head with a thick cloth to inhale more steam and prevent the water from cooling.
• Irrigate nasal passages
  Clean your nasal passage with a saltwater solution.
• Sleep with head in an elevated position
  This will prevent pooling of mucus, which typically happens when you sleep with your head in low position.
• Avoid high altitudes
  This includes travelling via flights. This is because pressure changes have a negative impact on sinusitis and may worsen your condition.
• Diet
  Some of the foods to be consumed and avoided are as follows:

Prognosis

Sinusitis can be treated by taking appropriate self-care steps along with the medications to control the symptoms and reduce inflammation. A timely diagnosis and thorough treatment are enough to cure it. Complications are rare.

Complications

The complications in sinusitis are infrequent, and include:

• Abscess formation or collection of pus in the sinus tissues.
• Infection of the surrounding structures of the sinuses e.g., around the eyes.
• Meningitis, a condition that occurs when infections spread up to the skull and affect the brain.

Although these complications are extremely rare, they require immediate steps, such as hospitalisation, surgery, and intravenous (direct administration into the veins) medications, for complete management.

Sinusitis is also known as rhinosinusitis because of the inflammation of the nasal cavity as well as the sinuses. It is one of the very frequently detected diseases worldwide, with about 12.83% of the Indian population reported with chronic sinusitis. Sinusitis can be classified into acute, recurrent acute, subacute, and chronic types.