Sinusitis
CONTENTS
You're coughing and sneezing and tired and achy. You think that
you might be getting a cold. Later, when the medicines you've been
taking to relieve the symptoms of the common cold are not working
and you've now got a terrible headache, you finally drag yourself to
the doctor. After listening to your history of symptoms, examining
your face and forehead, and perhaps doing a sinus X-ray, the doctor
says you have sinusitis.
Sinusitis simply means your sinuses are infected or inflamed, but
this gives little indication of the misery and pain this condition
can cause. Health care experts usually divide sinusitis cases into
- Acute, which last for 3 weeks or less
- Chronic, which usually last for 3 to 8 weeks but can continue
for months or even years
- Recurrent, which are several acute attacks within a year
Health care experts estimate that 37 million Americans are
affected by sinusitis every year. Health care providers report
nearly 32 million cases of chronic sinusitis to the Centers for
Disease Control and Prevention annually. Americans spend millions of
dollars each year for medications that promise relief from their
sinus symptoms.
Sinuses are hollow air spaces in the human body. When people say,
"I'm having a sinus attack," they usually are referring to symptoms
in one or more of four pairs of cavities, or sinuses, known as
paranasal sinuses . These cavities, located within the skull or
bones of the head surrounding the nose, include the
- Frontal sinuses over the eyes in the brow area
- Maxillary sinuses inside each cheekbone
- Ethmoid sinuses just behind the bridge of the nose
and between the eyes
- Sphenoid sinuses behind the ethmoids in the upper
region of the nose and behind the eyes
Each sinus has an opening into the nose for the free exchange of
air and mucus, and each is joined with the nasal passages by a
continuous mucous membrane lining. Therefore, anything that causes a
swelling in the nose—an infection, an allergic reaction, or another
type of immune reaction—also can affect the sinuses. Air trapped
within a blocked sinus, along with pus or other secretions, may
cause pressure on the sinus wall. The result is the sometimes
intense pain of a sinus attack. Similarly, when air is prevented
from entering a paranasal sinus by a swollen membrane at the
opening, a vacuum can be created that also causes pain.
The location of your sinus pain depends on which sinus is
affected.
- Headache when you wake up in the morning is typical of a sinus
problem.
- Pain when your forehead over the frontal sinuses is touched
may indicate that your frontal sinuses are inflamed.
- Infection in the maxillary sinuses can cause your upper jaw
and teeth to ache and your cheeks to become tender to the touch.
- Since the ethmoid sinuses are near the tear ducts in the
corner of the eyes, inflammation of these cavities often causes
swelling of the eyelids and tissues around your eyes, and pain
between your eyes. Ethmoid inflammation also can cause tenderness
when the sides of your nose are touched, a loss of smell, and a
stuffy nose.
- Although the sphenoid sinuses are less frequently affected,
infection in this area can cause earaches, neck pain, and deep
aching at the top of your head.
Most people with sinusitis, however, have pain or tenderness in
several locations, and their symptoms usually do not clearly
indicate which sinuses are inflamed.
Other symptoms of sinusitis can include:
- Fever
- Weakness
- Tiredness
- A cough that may be more severe at night
- Runny nose (rhinitis) or nasal congestion
In addition, the drainage of mucus from the sphenoid or other
sinuses down the back of your throat (postnasal drip) can cause you
to have a sore throat. Mucus drainage also can irritate the
membranes lining your larynx (upper windpipe). Not everyone with
these symptoms, however, has sinusitis.
On rare occasions, acute sinusitis can result in brain infection and
other serious complications.
Most cases of acute sinusitis start with a common cold, which is
caused by a virus. These viral colds do not cause symptoms of
sinusitis, but they do inflame the sinuses. Both the cold and the
sinus inflammation usually go away without treatment in 2 weeks. The
inflammation, however, might explain why having a cold increases
your likelihood of developing acute sinusitis. For example, your
nose reacts to an invasion by viruses that cause infections such as
the common cold or flu by producing mucus and sending white blood
cells to the lining of the nose, which congest and swell the nasal
passages.
When this swelling involves the adjacent mucous membranes of your
sinuses, air and mucus are trapped behind the narrowed openings of
the sinuses. When your sinus openings become too narrow, mucus
cannot drain properly. This increase in mucus sets up prime
conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus
pneumoniae and Haemophilus influenzae , in their upper
respiratory tracts with no problems until the body's defenses are
weakened or drainage from the sinuses is blocked by a cold or other
viral infection. Thus, bacteria that may have been living harmlessly
in your nose or throat can multiply and invade your sinuses, causing
an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although
fungi are abundant in the environment, they usually are harmless to
healthy people, indicating that the human body has a natural
resistance to them. Fungi, such as Aspergillus , can cause
serious illness in people whose immune systems are not functioning
properly. Some people with fungal sinusitis have an allergic-type
reaction to the fungi.
Chronic inflammation of the nasal passages also can lead to
sinusitis. If you have allergic rhinitis or hay fever, you can
develop episodes of acute sinusitis. Vasomotor rhinitis, caused by
humidity, cold air, alcohol, perfumes, and other environmental
conditions, also may be complicated by sinus infections.
Acute sinusitis is much more common in some people than in the
general population. For example, sinusitis occurs more often in
people who have reduced immune function (such as those with primary
immune deficiency diseases or HIV infection) and with abnormality of
mucus secretion or mucus movement (such as those with cystic
fibrosis).
It can be difficult to determine the cause of chronic sinusitis.
Some investigators think it is an infectious disease but others are
not certain. It is an inflammatory disease that often occurs in
patients with asthma. If you have asthma, an allergic disease, you
may have chronic sinusitis with exacerbations. If you are allergic
to airborne allergens, such as dust, mold, and pollen, which trigger
allergic rhinitis, you may develop chronic sinusitis. An immune
response to antigens in fungi may be responsible for at least some
cases of chronic sinusitis. In addition, people who are allergic to
fungi can develop a condition called "allergic fungal sinusitis." If
you are subject to getting chronic sinusitis, damp weather,
especially in northern temperate climates, or pollutants in the air
and in buildings also can affect you.
If you have an immune deficiency disease or an abnormality in the
way mucus moves through and from your respiratory system (e.g.,
primary immune deficiency, HIV infection, and cystic fibrosis) you
might develop chronic sinusitis with frequent flare-ups of acute
sinusitis due to infections. In otherwise normal individuals,
sinusitis may or may not be infectious. In addition, if you have
severe asthma, nasal polyps (small growths in the nose), or a severe
asthma attacks caused by aspirin and aspirin-like medicines such as
ibuprofen, you might have chronic sinusitis
Because your nose can get stuffy when you have a condition like
the common cold, you may confuse simple nasal congestion with
sinusitis. A cold, however, usually lasts about 7 to 14 days and
disappears without treatment. Acute sinusitis often lasts longer and
typically causes more symptoms than just a cold.
Your doctor can diagnose sinusitis by listening to your symptoms,
doing a physical examination, taking X-rays, and if necessary, an
MRI or CT scan (magnetic resonance imaging and computed tomography).
After diagnosing sinusitis and identifying a possible cause, a
doctor can suggest treatments that will reduce your inflammation and
relieve your symptoms.
Acute sinusitis
If you have acute sinusitis, your doctor may recommend
- Decongestants to reduce congestion
- Antibiotics to control a bacterial infection, if present
- Pain relievers to reduce any pain
You should, however, use over-the-counter or prescription
decongestant nose drops and sprays for only few days. If you use
these medicines for longer periods, they can lead to even more
congestion and swelling of your nasal passages.
If bacteria cause your sinusitis, antibiotics used along with a
nasal or oral decongestant will usually help. Your doctor can
prescribe an antibiotic that fights the type of bacteria most
commonly associated with sinusitis.
Nasal Wash can be
helpful. This will wash out the bacteria and congestion while making
the nasal & sinus environment unfriendly for bacterial. To do this you can use a netti
pot with salt water which you flush through your nose. Doing this
regularly when you have acute sinusitis can help reduce the duration. There also is some evidence that this can
help prevent colds when done daily.
Natural Treatments
A few herbs have shown efficacy in
clinical trials. One is
Bromelain which
helps break up the mucous and reduce inflammation.
Another is Andrographis Paniculata, Astragulus
Membranaceus, Schizandra Chinesis, Lingustum Lucidum in clinical studies
they were effective in both children and adults in both preventing
and shortening sinusitis. They help fight the both viruses and
bacteria as well as help reduce nasal inflamation.
More Information.
Many cases of acute sinusitis will end without antibiotics. If you
have allergic disease along with sinusitis, however, you may need
medicine to relieve your allergy symptoms. If you already have
asthma then get sinusitis, you may experience worsening of your
asthma and should be in close touch with your doctor.
In addition, your doctor may prescribe a steroid nasal spray, along
with other treatments, to reduce your sinus congestion, swelling,
and inflammation.
Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis
successfully, realizing that symptoms persist even after taking
antibiotics for a long period. As discussed below, many doctors
treat with steroids such as steroid nasal sprays. Many doctors do
treat chronic sinusitis as though it is an infection, by using
antibiotics and decongestants. Other doctors use both antibiotics
and steroid nasal sprays. Further research is needed to determine
what is the best treatment.
Some people with severe asthma are said to have dramatic improvement
of their symptoms when their chronic sinusitis is treated with
antibiotics.
Doctors commonly prescribe steroid nasal sprays to reduce
inflammation in chronic sinusitis. Although doctors occasionally
prescribe these sprays to treat people with chronic sinusitis over a
long period, doctors don't fully understand the long-term safety of
these medications, especially in children. Therefore, doctors will
consider whether the benefits outweigh any risks of using steroid
nasal sprays.
If you have severe chronic sinusitis, your doctor may prescribe oral
steroids, such as prednisone. Because oral steroids are powerful
medicines and can have significant side effects, you should take
them only when other medicines have not worked.
Although home remedies cannot cure sinus infection, they might give
you some comfort.
- Inhaling steam from a vaporizer or a hot cup of water can
soothe inflamed sinus cavities.
- Saline nasal spray, which you can buy in a drug store, can
give relief.
- Gentle heat applied over the inflamed area is comforting.
When medical treatment fails, surgery may be the only alternative
for treating chronic sinusitis. Research studies suggest that the
vast majority of people who undergo surgery have fewer symptoms and
better quality of life.
In children, problems often are eliminated by removal of adenoids
obstructing nasal-sinus passages.
Adults who have had allergic and infectious conditions over the
years sometimes develop nasal polyps that interfere with proper
drainage. Removal of these polyps and/or repair of a deviated septum
to ensure an open airway often provides considerable relief from
sinus symptoms.
The most common surgery done today is functional endoscopic sinus
surgery, in which the natural openings from the sinuses are enlarged
to allow drainage. This type of surgery is less invasive than
conventional sinus surgery, and serious complications are rare.
Although you cannot prevent all sinus disorders—any more than you
can avoid all colds or bacterial infections—you can do certain
things to reduce the number and severity of the attacks and possibly
prevent acute sinusitis from becoming chronic.
- You may get some relief from your symptoms with a humidifier,
particularly if room air in your home is heated by a dry
forced-air system.
- Air conditioners help to provide an even temperature.
- Electrostatic filters attached to heating and air conditioning
equipment are helpful in removing allergens from the air.
If you are prone to getting sinus disorders, especially if you
have allergies, you should avoid cigarette smoke and other air
pollutants. If your allergies inflame your nasal passages, you are
more likely to have a strong reaction to all irritants.
If you suspect that your sinus inflammation may be related to dust,
mold, pollen, or food—or any of the hundreds of allergens that can
trigger an upper respiratory reaction—you should consult your
doctor. Your doctor can use various tests to determine whether you
have an allergy and its cause. This will help you and your doctor
take appropriate steps to reduce or limit your allergy symptoms.
Drinking alcohol also causes nasal and sinus membranes to swell.
If you are prone to sinusitis, it may be uncomfortable for you to
swim in pools treated with chlorine, since it irritates the lining
of the nose and sinuses.
If you have a cold or flu and are
prone to Sinusitis the herbal combination Andrographis Paniculata, Astragulus
Membranaceus, Schizandra Chinesis, Lingustum Lucidum are
effective in
preventing its occurrence.
Divers often get sinus congestion and infection when water is forced
into the sinuses from the nasal passages.
You may find that air travel poses a problem if you are suffering
from acute or chronic sinusitis. As air pressure in a plane is
reduced, pressure can build up in your head blocking your sinuses or
eustachian tubes in your ears. Therefore, you might feel discomfort
in your sinus or middle ear during the plane's ascent or descent.
Some health experts recommend using decongestant nose drops or
inhalers before a flight to avoid this problem.
At least two-thirds of sinusitis cases caused by bacteria are due
to two organisms that can also cause otitis media (middle ear
infection) in children as well as pneumonia and acute exacerbations
of chronic bronchitis. There are multiple studies to better
understand the basis for infectivity of these organisms as well as
identifying potential candidates for future vaccines strategies that
could eliminate these diseases.
Scientific studies have shown a close relationship between having
asthma and sinusitis. As many as 75 percent of people with asthma
also get sinusitis. Some studies state that up to 80 percent of
adults with chronic sinusitis also had allergic rhinitis. On-going
research looks at allergic diseases as well as bacteria and fungus
that can cause sinusitis. This research is focused on developing
better treatments and ways to prevent these diseases.
Scientists are investigating whether chronic sinusitis has genetic
causes. They have found that certain alterations in the gene that
causes cystic fibrosis may also increase the likelihood of
developing chronic sinusitis. This research will give scientists new
insights into the cause of the disease in some people and points to
new strategies for diagnosis and treatment.
Another research study has recently demonstrated that blood cells
from patients with chronic sinusitis make chemicals that produce
inflammation when exposed to fungal antigens, suggesting that fungi
may play a role in many cases of chronic sinusitis. Further
research, including clinical trials of antifungal drugs, will help
determine whether, and for whom, this new treatment strategy holds
promise.
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