Sinusitis

Causes Of Sinusitis

Your sinuses are hollow spaces or cavities within the bones of the skull that connect to the nose through small, narrow channels. Sinuses are located behind the forehead, nasal bones, cheek bones, and in between the eyes. They contain mucus, which is a thin liquid that traps and moves away any germs, dust, pollutants and allergens entering the body through the nose. They also help to keep the air you breathe in, warm and moist.

Healthy sinuses are filled with air. Sinusitis or inflammation of sinuses happens when fluid builds up in these air-filled sinuses, allowing germs to grow and cause an infection. The causes of sinusitis can include various pathogens, environmental factors to irritants which are:

• Allergens

• Irritants (animal dander, polluted air, smoke, and dust)

• Bacteria

• Viruses

• Fungi

Types Of Sinusitis

The different types of sinusitis classified according to the timespan of symptoms are:

1. Acute Sinusitis: Symptoms usually last for 4 weeks or less. Cases mostly begin with symptoms of common cold such as a runny nose and facial pain. They are usually caused by viral or bacterial infections, or sometimes even seasonal allergies.

2. Subacute Sinusitis: Symptoms last from 4 to 12 weeks. This condition commonly occurs due to bacterial infections or seasonal allergies.

3. Chronic Sinusitis: Symptoms last more than 12 weeks despite medical treatment, and can continue for months or even years. They are often mild in severity. Bacterial or fungal infection, persistent allergies or structural nasal problems can usually cause this condition.
 

4. Recurrent Sinusitis: Characterised by several attacks of sinusitis within a year.

Symptoms Of Sinusitis

Depending on which sinus is involved, sinusitis causes pain along with a feeling of pressure: 

• In the forehead

• Over the cheek

• In the upper jaw and teeth

• Behind the eyes

• At the top of the head

Other common symptoms that can be seen along with the pain include:

• Blocked nose

• Nasal discharge

• Mucus dripping down the throat (post-nasal drip)

• Sore throat

• Cough

• Bad breath

• Reduced sense of smell and taste

• Fever 

• Frequent headaches

• Fatigue 

• Pain in upper jaw and teeth

• Ear pain

Is it a cold or sinus infection? 

As the symptoms of both cold and sinus infection are mostly similar, people often get confused between the two. However, both are different conditions. Here are some differences between them which will help you in gauging which one you have.

1. Time duration

This is the first and foremost sign of sinusitis. If you suffer from a common cold you may have a runny nose for 1-2 days, followed by a stuffy nose for 2-4 days. Post this, you may start to feel better. But if you have sinus infection, then the symptoms may stay for around seven days or more.

2. Nasal discharge

Another potentially helpful sign of sinusitis is the color of the nasal discharge. 

Note: A viral infection may produce a colorful discharge. However, bacteria produce greenish or yellow mucus.

3. Sinus headaches

The pressure and swelling in the sinus cause a headache. Sinus pain can also lead to dental pain, pain in the jaws and cheek and ear pain.

4. Pain in the sinuses

Pain is a very common symptom of sinusitis. The inflammation and swelling in the sinus cause a dull pressure, which leads to pain in your forehead, upper jaws, and teeth, either side of the nose, or between the eyes. This may gradually lead to a headache.

5. Throat irritation and cough

The sinus blockage may cause irritation in the throat. This can also lead to a persistent cough, which gets even more annoying when you are lying down to sleep.

REMEMBER! The main difference is the duration of symptoms. You will most probably recover from a cold  within 5-10 days. But, sinusitis can make you feel run down for 4 weeks (acute sinusitis) or for over 3 months (chronic sinusitis).

Risk Factors Of Sinusitis

Sinusitis is mostly seen in children younger than 15 years of age than in adults as the sinuses in kids are not fully developed. However, even adults in the age group of 25 to 64 years can suffer from sinus infections due to the triggers. Some of the common triggers or factors that increase your risk of sinusitis include:

• Respiratory tract infections. Infections of the respiratory tract like common colds may produce too much mucus which can block the opening of the sinuses.

• Nasal polyps or nasal bone spur can block the opening of nasal passages or sinuses.

• Deviated nasal septum in which the thin wall in the nose that separates the nostrils is displaced to one side thereby blocking or limiting the sinus passages. 

• Seasonal allergies from dust, pollen etc.

• Conditions that prevent cilia (move back and forth to help the mucus move out of the sinuses) from working properly like dehydration, drying medications like antihistamines, and lack of sufficient humidity in the air.

• Respiratory diseases such as cystic fibrosis which causes impaired mucus transport.

• Smoking including passive or secondhand smoke.

• Enlarged adenoids.

• Dental infection.

• Changes in barometric pressure during air travel or scuba diving.

• Patients with nasogastric or nasotracheal tubes.

• Weakened immune system from HIV or chemotherapy. 

Diagnosis Of Sinusitis

In most cases, sinusitis can be diagnosed based on the physical examination done by your general physician. This is usually based on your symptoms which also includes the duration and the severity. In some cases, your doctor might also ask you to get some tests done which includes:

1. CT Scan (PNS Coronal) or MRI (PNS)

Images taken using CT or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical blockage, such as polyps, tumors or fungi, that's difficult to detect using an endoscope. This is why a coronal CT scan or MRI is recommended for the diagnosis of sinusitis.

2. Microbial cultures

This test is requested in order to know the cause of the sinus infection in case of a bacterial or fungal infection. It is mostly advised in chronic sinusitis and in cases where the condition fails to improve or worsen even after treatment.

3. Nasal endoscopy

In this, a thin flexible tube (commonly known as an endoscope) with a light is inserted through the nose to check the inside of the sinuses.

4. Tests for Allergies

If your doctor suspects that the condition might have been triggered due to an allergy, then allergy testing might be advised. It is a simple skin test which helps to detect the allergen that causes a flare-up. It is a quick and safe test that can help you to know about any specific allergen which can trigger a flare-up.

5.  Biopsy

Although rare, your doctor might advise a biopsy if he/she suspects fungal sinus infection which can even penetrate through the bone. This can only be determined through tissue biopsy or bone biopsy based on the severity and the cause.

Prevention Of Sinusitis

You can lower your risk of suffering from sinus infections as well as relieve the early symptoms of sinusitis by following some simple tips and tricks that not only help to keep your nasal passages clear but also improve your overall ability to fight the infection. Here are some of the best ways to prevent sinusitis and stay healthy according to the CDC.

1. Always keep your hands clean

A proper hand hygiene ritual is the single most important and least expensive means of reducing the prevalence of infections. It also helps you to prevent the spread of germs and infections to others and prevent you from getting sick.

2. Be safe with vaccinations

The role of vaccines in lowering your risk of infections cannot be underestimated. It is always recommended to receive the flu vaccine and pneumococcal vaccine which help you to prevent seasonal flu and pneumonia respectively. It not only boosts your immune function but also helps you to fight infections.

3. Avoid people who have colds or other upper respiratory infections

It goes without saying that people who suffer from viral infections or colds are at a high risk of spreading the infections to others. As these infections can trigger sinusitis, it is highly recommended that one should avoid close contact with people who have cold or other upper respiratory infections to be on a safer side.

4. Stay away from triggers

If your sinusitis is triggered by smoking then it is wise to avoid smoking including secondhand smoke. The same rule applies to triggers such as seasonal allergies, dust, etc which are known to trigger a sinus infection.

5. Avoid dry environments

As dry air can make things worse for your sinuses, it is recommended to use a humidifier in your home (in particular, by your bed). This is because humidity in air can help prevent nasal passages from drying out and thus, lower your risk of infections. Also, remember to keep humidifiers clean to prevent any growth of mold.

Specialist To Visit

If you observe/experience any signs and symptoms of sinusitis, then it’s time to make an appointment with your doctor. Initially, you can visit a general physician and depending on the severity of the diseases or the cause of it, your doctor may refer you to a specialist such as:

• Otolaryngologist or ENT specialist

• Internal Medicine specialist

• Infectious disease specialist

• Allergist or Immunologist

• Head and neck surgeon in case of any surgery

Treatment Of Sinusitis

The treatment of sinusitis is based on the cause and severity of the condition. Some of the common treatment options for sinus infection include:

1. Antibiotics

If you suffer from bacterial sinus infections, then antibiotics are the most preferred and effective treatment that is recommended. Based on the symptoms and severity of the infection as well as the type of the antibiotics, it can be recommended from one week upto two weeks and beyond if there are any complications. In case of chronic infections, the treatment duration might be prolonged as well. However, do not self-medicate as it can increase the risk of antibiotic resistance. Some of the commonly recommended antibiotics include:

• Amoxicillin

• Trimethoprim-sulfamethoxazole

• Cefuroxime

• Clindamycin

• Ciprofloxacin

• Sulfamethoxazole

• Metronidazole

2. Decongestants

These medications help treat sinus infections by causing the swollen nasal passages to shrink. This in turn helps in the proper flow of drainage from the sinuses. These are available in the form of pills, nasal sprays as well as topical ointments. Examples of the commonly used decongestants for sinusitis are:

• Naphazoline

• Oxymetazoline

• Adrenaline

• Oxymetazoline+Sorbitol

• Phenylephrine

3. Antihistamines

If the cause of the sinus infection is an underlying allergic reaction or due to an allergen, then antihistamines are the preferred medications. These medications work by blocking the inflammation that causes the allergic reaction and help to fight the symptoms. These also help to treat swollen nasal as well as sinus passages, improving the condition. Examples include:

• Cetirizine

• Chlorpheniramine 

• Clemastine

4. Pain relief medications

As the name suggests, pain relief medications help in treating headaches which often accompany sinus infections. These are also known to help improve the symptoms and are mostly given along with other medications to treat the infection. Examples include:

• Paracetamol

• Ibuprofen

5. Nasal corticosteroids

These are available as nasal sprays which help to prevent and treat inflammation. Some of the common examples of medicine which belong to this class are:

• Fluticasone

• Fluticasone propionate

• Triamcinolone

• Budesonide

• Mometasone

• Beclomethasone

6.  Oral or injected corticosteroids

These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Commonly used corticosteroid is:

• Prednisolone

7. Other options

Saline nasal irrigation with nasal sprays or solutions reduces drainage and rinses away irritants and allergies. Additionally, use of heat pads on the inflamed area to soothe the pain or vaporizers to improve flow of mucus from the nose and relieve the symptoms is also recommended.

8. Surgery

If drug therapies fail to show any improvement in your condition, then surgery may act as a last resort. It is mostly done in people suffering from sinusitis caused due to underlying anatomical defects. An otolaryngologist (ENT Surgeon) is the right doctor who can fix defects in the bone separating the nasal passages, remove nasal polyps, and open up closed passages.

Home-care For Sinusitis

Most sinus infections usually get better on their own without antibiotics by taking proper self-care measures. Talk to your doctor about the best treatment in your case. Here are a few tips to help you feel better.

• Apply a warm compress on your face to soothe sinus pain.

• Use saline nasal drops daily to clear off any extra mucus and keep the nasal passages moist.

• Use a Neti pot or saline squeeze bottle to flush the sinuses.

• Keep yourself hydrated to thin the mucus.

• Inhale steam or take a long hot shower to open up your sinuses.

• Use a humidifier at home or workplace.

• Keep your head elevated while sleeping.

• Avoid extreme and sudden changes in temperatures and suddenly bending forward with your head down.

• Take anti-allergic medicines and decongestants only when prescribed.

Complications Of Sinusitis

Sinusitis can be diagnosed based on the symptoms and it can be treated effectively with use of medications such as antibiotics, decongestants, antihistamines and painkillers. However, if left untreated, it can lead to frontal or sphenoid sinusitis which can not only make it difficult to manage the symptoms but also leads to difficulty in swallowing & breathing.

Serious complications of chronic sinusitis are rare but may include:

• Abscess: collection of pus in the sinus cavity.

• Eye complications: If your sinus infection spreads to your eye, it can cause orbital cellulitis which is an infection of the tissue surrounding the eyes that can result in reduced vision or rarely loss of vision.

• Infections: Very rarely, people with chronic sinusitis may develop infections like meningitis (a life threatening infection that can cause brain and spinal cord damage) or osteomyelitis (bone infection).

Alternate Treatment For Sinusitis

Blocked sinuses are mostly a result of a bout of common cold or allergic conditions. More often than not, the sinuses can be freed using prescription drugs or nasal sprays. The nasal sprays can have side effects and it is best to limit their use. You can try simple and effective home-made remedies which often work better than these sprays and pills. Here are a few remedies that you can give a try:

1. Carom (Ajwain) seeds 

Add one tablespoon of carom seeds (ajwain seeds) to a pot of boiling water. Place the bowl under your face and cover your head and neck with a towel so that the steam directly hits your face and does not escape. Take deep breaths to clean your sinuses. You can also add peppermint oil or sage leaves to the water and inhale for 5-10 minutes.

2. Turmeric (Haldi)

The quintessential Indian spice, turmeric contains an active compound curcumin which is a very potent anti-inflammatory agent besides being a powerful antioxidant. Chewing a raw turmeric root on an empty stomach will loosen the accumulated mucus in the sinuses and let the blood vessels breathe easily thereby easing the blockage.

3. Garlic (Lehsun)

It is one of the most powerful natural antibiotics and helps relieve blocked sinuses when the cause is an infection or allergy. Its active component, Allicin, not only cures the blockage but even prevents it. Have a raw garlic clove on an empty stomach every day.

4. Tulsi

Tulsi or holy basil is a revered Ayurveda medicine that boasts of a range of health benefits. Having a few raw tulsi leaves and honey on an empty stomach boosts the immunity and fights conditions like sinus infections, common cold and blockage of sinuses.

5. Eucalyptus (nilgiri) oil

Eucalyptus oil is known for its decongestant and anti-inflammatory properties and provides instant relief from blocked sinuses. Add 3 to 5 drops of eucalyptus oil to boiling water in a large pot. Use a towel to cover your head and slowly inhale the steam through your nose for no more than 2 minutes at a time. Keep your eyes closed. Do it 2 times a day. Or else, just pour 1-2 drops of the oil on a clean handkerchief and inhale a few times.

6. Salt water 

Warm some water and add salt. Take a teaspoonful of the lukewarm water and snort it in with either your left or right nostril. It will come out through the other nostril. Do this a couple of times on each side and your clogging will reduce considerably. Use a Neti pot if you own one.

Living With Sinusitis

Living with sinusitis is knowing the right ways to prevent recurrence of the condition, relieving the symptoms and preventing attacks in case you do not have the infection yet. Here are a few tips on living with sinusitis:

1. Avoid foods that can trigger a reaction

Dairy products, refined sugars and processed foods should be limited or avoided as these foods tend to increase mucus production and trigger sinusitis.

2. Boost your immune system

People with weak immune systems are known to be at higher risks of suffering from the condition. People with weak immunity should take supplements and nutrients like vitamin C, multivitamin, zinc etc. 

3. Avoid allergens & smoking

If someone has indoor allergies it is recommended to avoid triggers like animal dander and dust mites. Smoking is never recommended, but if you do smoke, strongly consider a program to help you quit, as smoke can also trigger allergies and prevent removal of mucus by the nose. 

4. Dealing with the symptoms

Relieve sinusitis symptoms by following simple home remedies like using a humidifier, taking steam inhalation, using saline drops and staying hydrated. 

5. Take doctor’s advice 

Sinusitis should be taken seriously, and requires medical intervention, especially if the infection is chronic. It also helps to get treatment for other underlying infections that may be triggering sinusitis.