Dealing with that uncomfortable ailment that is Sinusitis

By Smriti Daniel

A dripping, inflamed nose accompanied by facial tenderness and headaches that make it difficult to even think, all add up to make sinusitis a singularly uncomfortable ailment.

Depending on the seriousness of your case, surgery may be called for. But before that, it is essential to eliminate other conditions - tumours or visual refractory problems - that can generate similar symptoms, says Dr. Ravindra Ruberu who as a Consultant ENT surgeon at the National Hospital, Sri Lanka, has seen his fair share of patients with sinusitis.

Sinuses: Helping you hold your head high

The role of the sinuses is not fully understood, says Dr. Ruberu explaining that, among other things, these air-filled cavities are believed to reduce the weight of the skull and give resonance to your voice. Sinuses are not self-contained: an opening in each sinus allows the free exchange of air and mucus into the nose, and each is connected to the nasal passages by a mucous membrane lining. This interconnectedness means that any inflammation in the nose - including that caused by an allergic reaction - can also affect your sinuses.

Air trapped within a blocked sinus, along with pus or mucus secretions may build up, thereby applying pressure on the sinus wall or blocking the opening altogether.

In human beings, sinuses are found in four places:

Your maxillary sinuses are the largest of your sinuses and are located just below your eyeballs, inside your cheekbones. When infected, this can result in tenderness in your cheek area, upper jaw and even in toothaches.

Your frontal sinuses are located just above your eyes and behind your brows. Infection can result in headaches and tenderness across your forehead.

Your ethmoid sinuses are found between your eyes, nested in your skull. When infected they can cause severe headaches and generate pressure or pain behind the eyes, swelling of the eyelids, stuffy, painful nose.

Your sphenoid sinuses are located behind the ethmoids and behind the eyes. Though these sinuses are less frequently affected, infection here is associated with earaches, neck pain, and a deep ache at the top of your head.

What is sinusitis?

"Sinusitis is an inflammation of the sinuses," says Dr. Ruberu. This inflammation often causes pain depending on which sinus is affected. A patient might also produce thick nasal secretions that are yellow, green, or blood-tinged. A stuffy nose and a sense of the face feeling swollen and tender is very common. However, other symptoms can include reduced sense of smell, cough, sore throat and fever.
What can predispose you to developing sinusitis? Someone still in the throes of a long term illness, whose immune system is weak, is vulnerable to sinusitis. In addition, people prone to allergies that affect the nose (like hay fever) are also more at risk. Rarely, fungal infections can cause sinusitis.

Dr. Ruberu explains that sinusitis can be divided into two categories:

Acute sinusitis: At the heart of many cases of acute sinusitis is a common cold. Contrary to the general view that acute means severe, in medical parlance the word is used to denote something that happens quickly, say within a few days. Nasal infections like the common cold or a bacterial infection occurring in the nose often fall into this category. Treatment for the cold and sinus inflammation usually results in the patient feeling better in a matter of days.

If the inflammation produced by the cold leads to a bacterial infection, however, then acute sinusitis can develop. Whatever the cause, a patient with acute sinusitis is likely to display symptoms such as a blocked or running nose, even as they suffer a loss of their sense of smell.

Pic courtesy

The last is caused by the inflammation associated with the cold, says Dr. Ruberu. This swelling in the mucus membranes of your sinuses, can also lead to air and mucus becoming trapped behind the narrowed openings of the sinuses. Drainage through the nose is hindered, and the trapped substance becomes a rich source of nutrients for bacteria to feed on.

It is worth noting that many of us unwittingly play host to bacteria like Streptococcus pneumoniae and Haemophilus influenza. Living in our throats and noses, they cause no problems. But when you have a cold, the increased susceptibility of the mucosa to infection due to the viral infection allows these bacteria to multiply and cause disease. Here, in the presence of trapped nutrients they begin to multiply at a rate.

Chronic sinusitis: A sinusitis attack that stretches into weeks or keeps recurring can be particularly difficult to cope with. Dr. Ruberu describes patients as having a long term nose block, bad headaches and the sensation of heaviness in the head. As in acute sinusitis, facial tenderness and pain is also common. If a patient has a weakened immune system or undergoes ineffective treatment, acute sinusitis can turn into chronic sinusitis. In some cases, the membranes that line the sinuses become thicker because of the long duration of the inflammation.

In a percentage of patients, nasal polyps are known to contribute to the occurrence of chronic sinusitis. These grape-like growths of the sinus membranes protrude into the sinuses or into the nasal passages, making it even more difficult for the sinuses to drain and for the patient to breathe. Also, on rare occasions, you might get unusual pathogens like T.B. causing chronic sinusitis reveals Dr. Ruberu.

Diagnosis and treatment

The case history is crucial, says Dr. Ruberu, emphasising that it must be thorough. The medical history must also be accompanied by an external examination of the face. If your symptoms are vague or persist, a doctor may suggest a computed tomography (CT) scan, in addition to laboratory tests which include blood tests to determine infection, and a test that analyses the material collected inside your sinus for bacterial or fungal infections.

"We should not assume that every headache that comes associated with a nose block is sinusitis," he says, explaining that occasionally tumours can mimic sinusitis, down to the haziness in CT scans. The eyes too must be examined carefully. "Visual refractory errors, especially in children, can cause headaches and because those headaches are also around the eyes and above the eyes it is easy to misdiagnose sinusitis," he warns.

If sinusitis is diagnosed, your doctor is likely to prescribe a combination of antibiotics, decongestants and if required, pain killers. Supportive therapies like steam inhalation can also greatly help relieve your discomfort. However, if a patient does not respond to treatment within 4-6 weeks, or if the sinusitis is a recurring condition, surgery might be called for, says Dr. Ruberu. Such surgery can remove any blockage in the sinuses and re-establish drainage thereby greatly relieving the patient's discomfort.

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